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Clinical Update

Deep Rivers Run Quiet. An Update on Social Anxiety Disorder

March 8, 2023

Steven Hamilton, MD, PhD. The Permanente Medical Group, Department of Psychiatry, Kaiser Permanente San Francisco Medical Center. Dr. Hamilton has no financial relationships with companies related to this material.

SSRIs and CBT treat social anxiety disorder, but what do you do when they don’t work? Steven Hamilton describes 5 other pharmacotherapy options and shows us how to distinguish social anxiety from normal shyness.

Optimal Antidepressant Doses in Major Depression

March 9, 2020

Kristen Gardner, PharmD.

Kristen Gardner, PharmD. Dr. Gardner has disclosed that she has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

More is not necessarily better in psychopharmacology. Some medications have plateau effect, while others follow a “U-shaped curve,” causing more problems as the dose goes too high. This metaanalysis looked at 77 dose-response trials with antidepressants to quantify their optimal therapeutic window.

Pharmacology for GAD: Complex Choices

November 15, 2019

Randall Moore, MD.

Randall Moore, MD. Dr. Moore has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

A meta-analysis of 25 medications in over 25,000 patients with generalized anxiety disorder. The usual FDA-approved options are there, along with some surprises. Not all are equal, but the most effective of the bunch carries so many side effects that we can only recommend it as a last resort.

Mirtazapine Augmentation: Running Low on Rocket Fuel

August 30, 2019

Thomas Jordan, MD and Chris Aiken, MD.

Thomas Jordan, MD and Chris Aiken, MD. Dr. Jordan and Dr. Aiken have disclosed that they have no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dubbed “California Rocket Fuel” by Stephen Stahl, the combination of venlafaxine and mirtazapine seemed to hit all the right receptors. The hype may have gotten a little ahead of the evidence on this one, however, as three new studies reveal.