The post-test for this issue is available for one year after the publication date to subscribers only. By successfully completing the test you will be awarded a certificate for 1 CME credit.
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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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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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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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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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Dr. Jim Phelps is the author of a textbook on bipolar spectrum disorders, A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management (W. W. Norton & Company) as well as two self-help books on bipolar disorder. He conducted some of the early studies on dark therapy out of his private practice in Oregon, and we caught up with him to learn about this novel treatment for bipolar disorder.
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You may have been hearing a lot of buzz about vortioxetine (Trintellix) and cognition. The FDA recently allowed a labeling change with this antidepressant that mentions specific benefits in cognitive symptoms of depression. Depressed patients tell us all the time how bad their memory is, and their concerns are valid.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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