Psychopharmacology Tips

Article

l-Methylfolate for Depression: Costly Mistake or Good Thinking?

Topics: Antidepressants | CAM Treatments | Deplin | Depression | Depressive Disorder | Folate | Folic Acid | l-methylfolate | methylfolate | Natural Medications | Nutrition | Pharmacology | Pharmacology Tips | Psychopharmacology | Psychopharmacology Tips | Treatment-Resistant Depression

Folate (Vitamin B9) has a long track record as a low-cost, low-risk augmentation strategy in depression. It’s also available in a more expensive form, l-methylfolate (Deplin), that promises better results but at a premium price. So, is the cost worth it? Folate pathwaysFolate (the natural form of folic acid) is a B vitamin that’s important in psych

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Expert Q&A

Medication Side Effects Part II: Weight Gain, Akathisia, Hair Loss, and Orthostasis

Topics: Akathisia | Falls | Hair loss | Orthostasis | Pharmacology Tips | Psychopharmacology Tips | Side Effects | Weight Loss Medications

Editor’s note: In the June/July issue, Dr. Mago shared a sampling of his strategies for nausea, sweating, and dry mouth. We wrap up that conversation here with a few more tips on managing side effects. Weight gain TCPR: What’s your approach to antipsychotic-induced weight gain? Dr. Mago: Prevention is better than treatment. So, when possible, we

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Article

Opioid Treatment Options

Topics: Free Articles | Practice Tools and Tips | Psychopharmacology Tips | Substance Abuse

Opioid use disorder (OUD) treatment can be tricky, in part because it doesn’t respond well to detox and counseling-only approaches. The overwhelming majority of people relapse after such attempts, or even become more vulnerable to overdose because of decreased tolerance after detoxing. And the trajectory in this country is worsening—in 2016, we aver

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Article

New Stimulants: From Remixed Amphetamines to Bedtime Ritalin

Topics: ADHD | Psychopharmacology Tips

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? To prepare you for the promotional downpour that’s likely to accompany all this repackagi

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Article

Harnessing Beneficial Drug Interactions

Topics: Practice Tools and Tips | Psychopharmacology Tips | Registered Articles

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 benef

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Expert Q&A

Effects of Drug Interactions

Topics: Practice Tools and Tips | Psychopharmacology Tips

TCPR: We’re seeing a lot of computer alerts for drug interactions. Which ones should we pay attention to? Dr. Sandson: The two issues to pay attention to are toxicity and loss of efficacy. Toxicity is the bigger concern, particularly if the drug has a “narrow therapeutic index,” where modest differences in the level can have dangerous effects. Li

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Article

How Ethnicity Influences Medication Response

Topics: Practice Tools and Tips | Psychopharmacology Tips

From cultural expectations to genetic variations, ethnicity has a strong effect on medication response. In this article, we’ll review five areas where ethnic groups can differ in their biological response to psychiatric medications. Drug metabolism Most medications are metabolized in the liver, and patients’ liver metabolism varies. Slow metabol

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Article

Non-Addictive, Pharmacological Options for Sleep

Topics: Addiction | Free Articles | Psychopharmacology Tips | Sleep Disorders | Substance Abuse

In this month’s interview with Dr. Eric Hermes, we learned about his approach to treating insomnia in patients with substance use disorders, with a focus on cognitive behavioral therapy. In this article, we’ll look at some non-addictive pharmacological options. That means we’re not going to review any of the benzodiazepines or the non-benzodiazepi

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Research Update

Is Varenicline Effective for Alcohol Use Disorder?

Topics: Addiction | Psychopharmacology Tips | Research Update | Substance Abuse

REVIEW OF: O’Malley S et al, JAMA Psychiatry 2018;75(2):129–138 Acting on the nicotinic acetylcholine receptors, varenicline (Chantix) is an FDA-approved treatment for smoking cessation. These receptors are implicated in both nicotine and alcohol reward pathways, so could varenicline also be helpful for treating alcohol use disorder (AUD)? So far

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Research Update

Youth, Antidepressant Medications, and Type 2 Diabetes

Topics: Antidepressants | Child Psychiatry | Psychopharmacology Tips

Review of: Burco M et al, JAMA Pediatrics 2017;171(12):1200–1207 Over the last decade, several published studies have reported an increased risk of type 2 diabetes associated with antidepressant use in adults. But does the same hold true for children and adolescents? This paper is the first population-based study to examine the risk of onset of

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Research Update

Guidelines for Switching From Methadone to Buprenorphine

Topics: Addiction | Psychopharmacology Tips | Research Update

REVIEW OF: Lintzeris N et al, J Addict Med 2018. doi:10.1097/ADM.0000000000000396 Recent guidelines published by the American Society of Addiction Medicine and nationally in Australia provide support for transferring patients from methadone to buprenorphine-naloxone (BNX). Patients may switch, thinking BNX is easier to discontinue or because of metha

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Article

Lithium: Practical Considerations for Children With Suicidal Thinking

Topics: Child Psychiatry | Depressive Disorder | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Billy, age 10, has periods of intense aggression alternating with moments of wanting to be dead, severe mood swings, poor sleep, and pervasive irritability. He has a family history of bipolar disorder. Other family members have responded well to lithium. Since they want to act assertively to help him, Billy’s family is open to medication trials and an

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Research Update

Evidence Behind Aripiprazole for the Treatment of Tourette’s Disorder

Topics: Child Psychiatry | Psychopharmacology Tips | Research Update

Review of: Sallee F et al,   J Child Adolesc Psychopharmacol 2017;27(9):771–781 Tourette’s disorder (TD) is a movement disorder emerging during childhood that causes persistent motor and vocal tics. TD is treated with a variety of medications, but often with an off-label designation. There are only three medications that are FDA approved for

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Article

Psychopharmacology for Patients With Intellectual Disability

Topics: Practice Tools and Tips | Psychopharmacology Tips

Anne, a 23-year-old woman with moderate intellectual disability, comes into your office accompanied by a staff member of her group home. The staffer reports that Anne has been aggressive toward her roommate and has appeared more aloof over the last week. He is ­curious whether you can prescribe a medication to prevent future episodes of aggression.

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Expert Q&A

Interviewing and Evaluating Patients With Intellectual Disability

Topics: Practice Tools and Tips | Psychopharmacology Tips

TCPR: Let’s start with the basics. What exactly is the definition of intellectual disability (ID)? Dr. Gentile: DSM-5 identifies it as an IQ of 70 or lower. Then there are ranges: mild, moderate, and severe/profound. Someone in the mild range has an IQ, generally, of 70 at the upper end and 50 to 55 at the lower end. The moderate range is 50 or 55

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Article

Helping People With Co-Occurring Mental Health and Substance Use Disorders

Topics: Practice Tools and Tips | Psychopharmacology Tips | Substance Abuse

Patients with co-occurring disorders (COD, also known as “dual diagnosis”) are often regarded as among the most challenging patients to treat. You need to track two conditions that interact in unpredictable ways, with patients who may not be inclined to follow your recommendations. It’s no surprise that such patients typically have poorer outcomes

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CME Post-Test

Take The CME Post-Test for Dual Diagnosis, CATR, August 2017

Topics: Practice Tools and Tips | Psychopharmacology Tips | Research Updates | Substance Abuse

The post-test for this issue is available for one year after the publication date to subscribers only (December 31, 2017). By successfully completing the test you will be awarded a certificate for 1 CME credit. Click here to take your CME test. Note: All of the CME tests are available in the “My Account” section of the site when you are logged

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Article

Beginning Antidepressant Treatment: A Recommended Approach

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

How do you start a new patient on antidepressant treatment? We do this countless times in our practices, and reviewing the topic may feel a bit like returning to residency. However, it’s important to revisit our standard operating procedures from time to time to ensure we’re thinking carefully about our decisions during our busy days. If we turn

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Expert Q&A

When First-Line Depression Treatments Don’t Cut It: Newer Antidepressants and Sometimes, Antipsychotics

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips | Registered Articles

TCPR: It’s been about 10 years since we last talked with you about the practical use of antidepressants with so many drugs to choose from. Over the last few years, three new antidepressants have come out: vilazodone (Viibryd), vortioxetine (Trintellix), and levomilnacipran (Fetzima). My sense is that an awful lot of clinicians still haven’t changed

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Expert Q&A

When Depression Meds Fail, Transcranial Magnetic Stimulation Might Be Plan B

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

TCPR: How treatment-resistant does a patient have to be with antidepressants before you should consider trying TMS? Dr. Becker: When TMS initially came out in 2008, it was approved for people who had failed one medication trial. But I’ll tell you, from doing a number of insurance reviews, that health insurers are going to require on average about f

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