• Subscribe
  • Register for free Content
  • Cart
  • Login
  • Browse by Topic
    • 13 Reasons Why
    • Abstinence
    • Acamprosate
    • Addiction
    • Addiction Treatment
    • Addyi
    • Adhansia XR
    • ADHD
    • Adherence
    • adolescents
    • Adult ADHD
    • Adverse Childhood Experiences (ACES)
    • Affordable Care Act (ACA)
    • Agitation
    • air pollution
    • Akathisia
    • Alcohol
    • Alcohol Use
    • Alcohol use disorder
    • Alcoholism
    • Alpha Agonists
    • Alternative treatments
    • Amantadine
    • amphetamine
    • Amphetamines
    • Anorexia Nervosa
    • Antidepressant Augmentation
    • Antidepressants
    • Antipsychotic
    • Antipsychotics
    • Anxiety
    • Anxiety Disorder
    • APA CE Post-Test
    • Aripiprazole
    • ArModafinil
    • Asenapine
    • Assessment
    • asthma
    • atamoxetine
    • attention
    • Attention Deficit Hyperactivity Disorder
    • Atypical Antipsychotics
    • Austedo
    • Autism
    • Autism Spectrum Disorder
    • Autism Spectrum Disorder
    • Autism Spectrum Disorder autism spectrum disorder
    • Behavior therapy
    • Behavioral addiction
    • Behavioral therapy
    • Behavioral treatment
    • Belsomra
    • Benzodiazepines
    • Beta-blockers
    • Billing
    • Bipolar Depression
    • Bipolar Disorder
    • Bipolar II
    • Board Certification
    • Borderline Personality Disorder
    • BPD
    • Brain Devices
    • Brief psychotherapy
    • Brief Strategic Family Therapy (BFST)
    • Bullying
    • Buprenorphine
    • Bupropion
    • C-Reactive Protein
    • Caffeine
    • CAM Treatments
    • Cannabidiol
    • Cannabis
    • Caplyta
    • Carbamazepine
    • Cardiovascular
    • Cariprazine
    • Chantix
    • Child and adolescent
    • Child Psychiatry
    • Child Psychiatry
    • children
    • Chokroverty
    • Citalopram
    • Clinical practice
    • Clozapine
    • CME Post-Test
    • Co-occurring disorders
    • Cocaine
    • Cognition
    • Cognitive Behavioral Therapy
    • Cognitive Decline
    • cognitive impact
    • Cognitive Rehabilitation Therapy (CRT)
    • Collaborative care
    • community trauma
    • Comorbidity
    • Complementary treatments
    • Complimentary treatments
    • Computer addiction
    • Computers in Psychiatric Practice
    • Conduct Disorder
    • Confidentiality
    • Connect
    • Connection
    • Connections
    • Contagion
    • Coronavirus
    • Cosmetic pharmacology
    • COVID-19
    • COVID19
    • Crime
    • Criminal behavior
    • Crisis intervention
    • Crocus Sativus
    • CRP
    • Cultural Competence
    • Culture
    • Cymbalta
    • Dayvigo
    • Delusional Disorder
    • Dementia
    • Deplin
    • Deprescribing
    • Depression
    • Depressive Disorder
    • Deutetrabenazine
    • Diagnosis
    • Diagnostic Testing
    • Disaster
    • Disparities
    • Diversity
    • Dopamine
    • DSM
    • Dual diagnosis
    • Duloxetine
    • Dyslexia
    • Dysregulation
    • E-Cigarettes
    • Eating Disorders
    • eCigarettes
    • ECT
    • Effexor
    • efficacy
    • electronic use
    • emergent suicidality
    • Emotional dysregulation
    • End of Life Care
    • Engagement
    • Escitalopram
    • Esketamine
    • eTNS
    • Exercise
    • Existing marijuana
    • expressed emotion
    • extended-release
    • Falls
    • Family Separation
    • FDA Warnings
    • Female hypoactive sexual desire disorder
    • Female Issues in Psychiatry
    • Fluoxetine
    • Folate
    • Folic Acid
    • Free Articles
    • gabapentin
    • GAD
    • Gender
    • Gender & Sexuality
    • Gender Diverse
    • Gender Dysphoria
    • Gender Identity
    • Generalized Anxiety Disorder
    • Generics
    • GeneSight
    • Genetic Testing
    • Genetics and Psychiatry
    • Geriatric Psychiatry
    • Ginkgo
    • Guanfacine
    • Hair loss
    • Harm reduction
    • Head Trauma
    • Health Apps
    • Heart health
    • Heart rate
    • Hepatitis
    • Heroin
    • HIPAA
    • Histamine
    • HIV
    • Hormone Replacement Therapy
    • Hypnotics
    • Hypomania
    • Incarceration
    • Inflammation
    • Ingrezza
    • Inpatient Psychiatry
    • inquiry
    • Insomnia
    • Insurance
    • Internet
    • Interpreter
    • Intervention
    • Irritability
    • Keppra
    • Ketamine
    • l-methylfolate
    • Laboratory Testing in Psychiatry
    • Lamictal
    • Lamotrigine
    • Language
    • Lavender
    • Learning & Developmental Disabilities
    • Legal issues
    • Lemborexant
    • Levetiracetam
    • LGBT
    • LGBTQ+
    • Life coaching
    • Life expectancy
    • Light and Dark Therapy
    • Light therapy
    • Lightbox
    • Literacy
    • Lithium
    • Longevity
    • Low libido
    • Lumateperone
    • Lurasidone
    • Lyrica
    • Management
    • Mania
    • MAOIs
    • Marijuana
    • Media
    • Medical Comorbidities
    • Medication
    • Medication adherence
    • Melatonin
    • Meta-analysis
    • Metabolic syndrome
    • Metformin
    • Methadone
    • methylfolate
    • methylphenidate
    • Micronutrients
    • Mind-Gut Connection
    • Mindfulness
    • Minority
    • Mirtazapine
    • Mixed Features
    • Modafinil
    • Mood Stabilizers
    • Mortality
    • Motivational Interviewing
    • Naloxone
    • Naltrexone
    • Narcolepsy
    • Natural Medications
    • natural treatments
    • Negative Symptoms
    • Netflix
    • Neurology
    • Neuroscience in Psychiatry
    • Neurotoxicity
    • New York
    • News of Note
    • Nightmares
    • Norepinephrine
    • Nortriptyline
    • Novel Medications
    • Nuedexta
    • Nuplazid
    • Nutrition
    • Nuvigil
    • Obesity
    • OCD
    • olanzapine
    • online therapy
    • Opioid epidemic
    • Opioid Use Disorder
    • Opioids
    • Oral Contraceptives
    • Orexin
    • Orthostasis
    • Outpatient
    • Overdose
    • Oxcarbazepine
    • Pain
    • pandemic
    • Panic Disorder
    • Parenting Strategies
    • Parkinson’s
    • Parkinson’s Disease
    • Paroxetine
    • Particulate matter
    • Patch
    • Patient relationship
    • pediatric
    • Perseveration
    • Perseverative Behavior
    • Personality Disorders
    • Pharmaceutical Industry
    • Pharmacology
    • Pharmacology Tips
    • Pharmacy
    • phonemic awareness
    • Phonics
    • Physician assisted suicide
    • PICOT
    • Pimozide
    • Pitolisant
    • Podcast
    • polypharmacy
    • Postpartum Depression
    • Potency
    • Practice Tools and Tips
    • Practice Tools and Tips
    • Pramipexole
    • Prazosin
    • Pregabalin
    • Pregnancy
    • prescribing patterns
    • Prescription costs
    • Prevention
    • Primary care
    • Prison
    • Prodrome
    • Prolonged exposure
    • Promotoras
    • Pronouns
    • Provigil
    • Prozac
    • pseudobulbar affect
    • Psychiatric interviewing
    • Psychological First Aide
    • Psychopharm Myths
    • Psychopharmacology
    • Psychopharmacology Tips
    • Psychosis
    • Psychotherapy
    • Psychotherapy
    • Psychotic Depression
    • Psychotropic medication
    • PTSD
    • Public health
    • Quetiapine
    • Randomized controlled trial
    • rapid naming
    • Reading
    • Reading disorder
    • Reading Disorders
    • Reading remediation
    • Red Cross
    • Registered Articles
    • Relationships
    • Remediation
    • Repetitive Behavior
    • Repetitive behaviors
    • Research
    • Research Update
    • Research Updates
    • retention
    • Retirement
    • Risk
    • Risk Management
    • Risperidone
    • Ritalin
    • rTMS
    • safety
    • Saffron
    • Saphris
    • Schizophrenia
    • School Refusal
    • Seasonal Affective Disorder
    • Secuado
    • Self-injury
    • Self-Regulation
    • Serotonin Specific Reuptake Inhibitors (SSRIs)
    • Sertraline
    • Sex Therapy
    • Sexual Dysfunction
    • Sexual Side Effects
    • Side Effects
    • Silexan
    • Skype
    • Sleep
    • Sleep Apnea
    • Sleep Disorders
    • Smoking Cessation
    • Smoking Cessation Agents
    • smoking cessations
    • Social Anxiety Disorder
    • social cohesion
    • Special populations
    • SSRIs
    • Stereotypical Behavior
    • steroids
    • Stigma
    • stimulant
    • Stimulants
    • structured literacy
    • Suboxone
    • Substance Abuse
    • Substance Abuse
    • Substance Use
    • Substance Use Disorder
    • Substance use disorders
    • Suicidality
    • Suicide
    • Suvorexant
    • Symptom Assessment
    • Symptom Management
    • Systematic review
    • Tardive dyskinesia
    • Technology
    • Teen
    • teens
    • Telehealth
    • Telemed
    • Telemedicine
    • Telepsychiatry
    • test cme quiz
    • TGD
    • Therapy during medication appointment
    • Therapy with Med Management
    • TMS
    • Tobacco
    • tobacco research
    • Tobacco use disorder
    • Toxic Stress
    • Transcranial Magnetic Stimulation
    • Transdermal
    • Transgender
    • Translator
    • Trauma
    • Trauma Informed Care
    • Traumatic Brain Injury (TBI)
    • Trazodone
    • treatment
    • treatment pediatric
    • Treatment planning
    • Treatment-Resistant Depression
    • Trigeminal Nerve Stimulation
    • Trintellix
    • Understanding Psychiatric Research
    • Valbenazine
    • Vaping
    • Varenicline
    • Venlafaxine
    • videogaming addiction
    • Vitamin B6
    • Vitamin D
    • Vitamin E
    • VMAT2 Inhibitors
    • Vortioxetine
    • Vyleesi
    • Wakix
    • Weed
    • Weight gain
    • Weight Loss Medications
    • Wellbutrin
    • Wilderness Therapy Programs
    • Withdrawal
    • Women's Issues in Psychiatry
    • Women’s Issues in Psychiatry
    • Working With Families
    • Youth
  • HOME
  • STORE
  • CME CENTER
  • Blog
  • Podcast
  • NEWSLETTERS
    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
  • Archive
  • Archive
  • Archive
  • The Carlat Psychiatry Report
  • Treatment-Resistant Depression (July/August)
  • Antidepressant Augmentation Strategies: A Basic Guide

Antidepressant Augmentation Strategies: A Basic Guide

The Carlat Psychiatry Report, Volume 16, Number 6&7, July 2018
https://www.thecarlatreport.com/newsletter-issue/tcprv16n6-7/

From The Carlat Psychiatry Report, July 2018, Treatment-Resistant Depression

Issue Links: Learning Objectives | Editorial Information | PDF of Issue

Topics: Antidepressants | Free Articles

Print Friendly, PDF & Email

Chris Aiken, MD

Editor-in-chief of The Carlat Psychiatry Report
Practicing psychiatrist, Winston-Salem, NC.

Here’s a common scenario. You have a patient who has tried three or four antidepressants over the years; all have been somewhat effective at least initially, but eventually that effectiveness waned.

Let’s imagine that the patient you’re seeing now is on antidepressant number 4, Lexapro, at a solid 20 mg dose. You could always keep pushing the dose, but there’s little evidence for this. You could switch to yet another antidepressant, but your intuition says it’s time to augment. Plus, recent studies have reported that augmentation outperformed placebo by 2:1 (Zhou X et al, J Clin Psych 2015;76:e487–e498), and that switching medications was no more effective than doing nothing (Bschor T et al, J Clin Psych 2018;79).

Drawing from both the literature and my own clinical experience, the following is a reasonable approach to choosing an augmentation strategy.

Atypical antipsychotics
The atypicals are the best-studied TRD augmentation agents, and among atypicals I favor aripiprazole for a couple of reasons: It has more positive trials than the other atypicals, and along with the less-well-studied risperidone, aripiprazole was one of only 2 atypicals that improved functioning and quality of life in a recent meta-analysis (Zhou X et al, Int J Neuropsychoph 2015;18:pyv060).

To avoid the most common side effect of akathisia, start low and increase slowly (eg, start with 1–2 mg daily for 7 days then 5 mg daily). Have patients start by taking it in the morning—although tell them that because it causes fatigue in about 10% of patients, they might prefer evening dosing. The 2 mg dose is no better than placebo, and aripiprazole has dose-dependent benefits (and side effects) between 5–15 mg per day. The average dose in the efficacy trials was 11 mg, but I usually allow an adequate trial at 5 mg (2–4 weeks) before raising the dose.

After aripiprazole, my choice is usually guided by side effects and costs, but the path around those side effects is rarely clear of thorns. Those with less sedation and weight gain (aripiprazole, brexpiprazole, cariprazine) tend to cause more akathisia. In the depression trials, overall tolerability was highest for risperidone and lowest for quetiapine. However, quetiapine’s low rate of akathisia and EPS makes it attractive for some patients, and risperidone’s high rate of prolactinemia is a drawback for others. Ziprasidone has the lowest risk of weight gain and metabolic effects, but the data supporting its use in augmentation are limited to a single positive trial, and ziprasidone carries additional risks of QT prolongation.

Generally, the atypicals can work with any antidepressant, although most were paired with an SSRI in the augmentation trials. One exception is olanzapine, which is FDA-approved only as an augmenter to fluoxetine in the form of OFC. Eli Lilly, which patented olanzapine and fluoxetine, sought approval for its combined OFC product in TRD rather than studying its antipsychotic for more general augmentation. That story takes an ironic turn in Zhou’s meta-analysis of atypicals in TRD, where OFC turned out to have the lowest efficacy despite being the only medication with a specific TRD indication. Zhou’s study turned up a different kind of surprise for the off-label risperidone, whose efficacy for antidepressant augmentation surpassed that of 2 FDA-approved options (quetiapine and OFC).

The efficacy of these agents is flipped in bipolar depression, where the effect size is largest for OFC and almost negligible for aripiprazole (Taylor DM et al, Acta Psychiatr Scand 2014;130:452–469). In bipolar depression, the atypicals should be used as monotherapy, except for olanzapine, which only works when combined with fluoxetine. In contrast, all of these agents require an antidepressant to work in unipolar depression, unless mixed features are part of the presentation, in which case they may work on their own—lurasidone has the best evidence for those cases (Suppes T et al, Am J Psychiatry 2016;173(4):400–407).

Lithium
After the atypicals, lithium is the second-best studied augmentation option for TRD, but I would consider it first-line in patients who are at risk for suicide. Lithium’s antisuicide effects are supported by epidemiologic data as well as controlled studies, and they are partly independent of its effects on mood. In a meta-analysis of 34 studies involving 110,000 person-years, lithium reduced the risk of suicide fivefold in recurrent unipolar depression and sixfold in bipolar disorder (Tondo L et al, Curr Psychiatry Rep 2016;18:88). A more recent case-control study has confirmed that effect and added another 410,000 life-years to the data (Song J et al, Am J Psychiatry 2017;174(8):795–802).

Lithium’s tolerability is comparable to the atypicals, and its side effects are further reduced by starting low (150–300 mg) and raising slowly (every 5 days toward 900 mg). From that point, I’ll dose by serum level (0.5–0.8 mmol/L is ideal for depression). Response should be seen in 2–6 weeks of achieving an adequate level. The controlled release versions reduce most side effects by about 50%, although they can cause more diarrhea.

Lithium’s main drawback is the risk of renal insufficiency, which is reduced by giving the entire dose at night (Gitlin M, Int J Bipolar Disord 2016;4:27). Check labs (basic chemistries, calcium, TSH, and lithium level) every 6–12 months and consult a nephrologist if the creatinine rises above 1.5. Hypothyroidism is relatively common on lithium (10%–20%), and even subclinical hypothyroidism may be worth treating. In a controlled trial of bipolar depression, lithium worked best when the TSH was maintained around 2.4 mIU/mL (Frye MA et al, Acta Psychiatr Scand 2009;120:10–13).

Thyroid
Augmenting an antidepressant with thyroid is often overlooked but well-supported by the data. Thyroid, lithium, and the atypicals were the only augmentation agents that reached statistical significance for TRD in Zhou’s meta-analysis of 48 studies. All those options carry medical risks, and in the case of thyroid, the concerns are arrhythmia, bone demineralization, and hypoglycemia (in diabetics). Thyroid augmentation is more effective in patients with subclinical hypothyroidism, but those with normal TSH levels can benefit as well.

Among the thyroid formulations, T3 (liothyronine, or Cytomel) is better studied than T4 (levothyroxine, or Synthroid) and was superior to T4 in a double-blind comparison (Joffe RT et al, Neuroendocrin Letters 1987;9:172). T3 is the more active form in the central nervous system, and some patients have difficulty converting T4 to T3. After checking a baseline thyroid panel, I will start T3 at 12.5–25 mcg/day and increase every 7 days toward a dose of 50 mcg daily. A thyroid panel should be checked at baseline and 4–6 weeks after reaching the target dose. Routine TSH can be checked every 6 months, and the dose should be lowered or discontinued if TSH < 0.5 mIU/L.

Other augmenters
Mirtazapine can reduce common serotonin side effects such as nausea, insomnia, akathisia, and sexual dysfunction, thus it is useful for augmenting serotonergic medications. Its use is backed by small studies, and a large trial is underway. L-methylfolate works preferentially in patients who are older, obese, or carry the MTHFR c-677t allele (Papakostas GI et al, J Clin Psych 2014;75:855–863).

I’ve tried many other emerging treatments, from statins to celecoxib, and the one I’ve seen the most benefit with is pramipexole. This dopaminergic agent treats both unipolar and bipolar depression with a large effect size, so it is a good choice when the diagnosis is unclear. In a small, controlled trial of TRD, it had a modest effect, and open-label data suggest it may work in cases that are resistant to ECT (Cusin C et al, J Clin Psychiatry 2013;74(7):e636–641). Outside of nausea, pramipexole is well-tolerated, with negligible effects on weight, sex drive, and cognition. The main concern with its use is pathological gambling, which can also occur with other dopamine agonists, such as aripiprazole. The gambling does not present with manic symptoms and is instead part of a spectrum of compulsive-hedonic behaviors that can happen with dopaminergics, such as shopping, masturbation, or excessively organizing the garage (Aiken C, J Clin Psych 2007;68:1230–1236).

Despite failing in research, a few augmentation strategies remain common in practice, including bupropion and the stimulants (specifically methylphenidate and lisdexamfetamine). I would use these as a last resort—I tend to take heed when manufacturer-supported trials are unable to show a benefit for their product, as was the case with these (including a large bupropion study that is unpublished). Novel stimulants (modafinil and armodafinil) have a limited role in treating apathy and fatigue, but patients usually appreciate that relief (Zhou X et al, J Clin Psych 2015;76:e487–e498).

When to stop?
I’ll attempt to slowly withdraw an augmentation agent after 3–6 months of recovery, especially if it poses medical risks. The slower the taper, the better: at least 3 months for lithium and 2–6 weeks for others.

Switching and raising the dose
Switching antidepressants is the least effective strategy in TRD but may work after 1 failed trial. Evidence supports a small benefit with switches to venlafaxine, vortioxetine, the tricyclics (especially in melancholic depression), and the MAOIs (especially in atypical depression) (Cowen PJ, Psychol Med 2017;47:2569–2577).

Raising the dose is a common strategy, especially for an antidepressant that’s become less effective over time, but controlled trials support a dose-dependent response for only a few antidepressants: MAOIs, tricyclics, bupropion, venlafaxine, mirtazapine, and vortioxetine (but not vilazodone).

What about ECT and TMS? These are beyond the scope of this article but should never be far from consideration in TRD. ECT remains the gold standard, with efficacy that surpasses that of TMS or any medication strategy (Berlim MT et al, Depress Anxiet 2013;30:614–623).

Suggested Articles

  • Communicating With Patients About Gender August 5, 2020 What are the risks for depression and suicide with transgender patients and how can we…

Powered by Contextual Related Posts

Share this page!
Subscribe
Register for free content

Register For Free Articles

Register to receive free email newsletters with concise, practical advice for busy clinicians. You will also have access to select article content on the website and you will receive notifications of new books and special discount offers.




Courses and Book CME
Psychiatry Practice Boosters, Third Edition (2021)
The Medication Fact Book for Psychiatric Practice, Fifth Edition (2020)
2021 Carlat Psychiatry Report Self-Assessment Course
2020 Carlat Psychiatry Report Self-Assessment Course
The Child Medication Fact Book for Psychiatric Practice (2018)
Issue Archives

2020

  • Esketamine (January)
  • Telepsychiatry (May)
  • Mind-Gut Connection (January)
  • Practical Psychotherapy (November/December)
  • Mood and Menopause (October)
  • When to Use Lithium (September)
  • Traumatic Brain Injury (August)
  • Borderline Personality Disorder (June/July)
  • Psychopharmacology Algorithms (April)
  • Bipolar II (March)
  • Inflammation and Depression (February)

2020

  • Mood Disorders in Children and Adolescents (Oct/Nov/Dec)
  • Identity & Culture in Children and Adolescents (July/August/September)
  • Psychosis in Children and Adolescents (April/May/June)
  • ADHD in Children and Adolescents (Jan/Feb/Mar)

2020

  • Harm Reduction (January/February)
  • Substance Use in Health Professionals (March/April)
  • Alternative Treatment in Addiction (November/December)
  • Social Aspects of Addiction (September/October)
  • Opioid Use Disorder Treatment (July/August)
  • Emerging Risks for Old Medications (May/June)

2019

  • Depression (May)
  • Adult ADHD (November/December)
  • Mental Health Apps (October)
  • How to Talk about Medication (September)
  • Side Effects Part II (August)
  • Side Effects Part I (June/July)
  • Sleep (April)
  • Parenting, Pregnancy, and Prevention (March)
  • Dark and Light Therapy (February)
  • Deprescribing (January)

2018

  • Drug Metabolism (November/December)
  • Working With Transgender Patients (October)
  • Emergency Psychiatry (September)
  • Treatment-Resistant Depression (July/August)
  • Neurobiology (June)
  • Anxiety (May)
  • Neurofeedback (April)
  • Antipsychotics Update (March)
  • Working With Families (February)
  • Bipolar Disorder (January)

2017

  • PTSD (December)
  • Retirement (November)
  • Intellectual Disability (September/October)
  • Antidepressants (July/August)
  • Personality Disorders (June)
  • Dementia (May)
  • Cognitive Behavior Therapy Techniques (April)
  • Pharmacogenetics (March)
  • Treating Psychosis (February)
  • Adult ADHD (January)

2016

  • Complementary and Alternative Medicine in Psychiatry (November/December)
  • Side Effects (October)
  • Pain Management (September)
  • Medication in Pregnancy (July/August)
  • Psychoanalysis in Modern Psychiatry (June)
  • Correctional Psychiatry (May)
  • Antidepressant Roundup (April)
  • Burnout (March)
  • Private Practice (February)
  • Bipolar Disorder (January)

2015

  • Psychiatry and General Medicine (November/December)
  • Biomarkers in Psychiatry (May)
  • Telepsychiatry (October)
  • Sleep Disorders (September)
  • Interventional Psychiatry (July/August)
  • Eating Disorders (June)
  • Psychotherapy Updates (April)
  • Topics in Geriatric Psychiatry (March)
  • Antipsychotics Update (February)
  • Risk Management (January)

2014

  • Bipolar Disorder (November/December)
  • Pharmacogenetics (October)
  • Keeping up in Psychiatry (September)
  • Research in Psychiatry (July/August)
  • Marijuana (June)
  • Psychiatric Diagnosis (May)
  • Issues in Psychopharmacology (April)
  • Schizophrenia (March)
  • Women’s Psychiatry (February)
  • Ethics in Psychiatry (January)

2013

  • Military Psychiatry (December)
  • Depression (November)
  • Treatment of Dementia (October)
  • Anxiety Disorders (September)
  • Natural and Alternative Treatments in Psychiatry (July/August)
  • Autism Spectrum Disorder (June)
  • Practice Tips (May)
  • Substance Abuse (April)
  • Medicolegal Topics (March)
  • End of Life Care (February)
  • Antipsychotic Update (January)

2012

  • Screening Tools and Tips (December)
  • Medical Comorbidities (November)
  • Devices in Psychiatry (October)
  • Eating Disorders (September)
  • Bipolar Disorder (July/August)
  • Risk Management (June)
  • Antidepressant Roundup 2012 (May)
  • Gender and Sexuality (April)
  • Personality Disorders (March)
  • ADHD (February)
  • Natural Treatments in Psychiatry (January)

2011

  • Electronic Medical Records (December)
  • Insomnia (November)
  • Psychotherapy (October)
  • Alcoholism (September)
  • Anxiety Disorders (July/August)
  • Schizophrenia (June)
  • Managing Side Effects (May)
  • Antidepressant Roundup 2011 (April)
  • DSM-5 and Diagnostic Issues (March)
  • Drug-Drug Interactions (February)
  • Bipolar Disorder (January)

2010

  • Hospital Psychiatry (December)
  • Psychiatric Medication in Pregnancy (November)
  • Maintenance of Certification (October)
  • The Neuroscience of Psychotherapy (September)
  • Treatment of Depression (July/August)
  • Email and the Internet in Psychiatry (June)
  • Substance Abuse (May)
  • The Diagnosis and Treatment of Dementia (April)
  • Ethics in Psychiatry (March)
  • Natural Treatments in Psychiatry (February)
  • ADHD (January)

2009

  • Treating Schizophrenia (December)
  • Treatment for Anxiety Disorders (November)
  • The Latest on Antidepressants (October)
  • Topics in Neuropsychiatry (September)
  • The Interface of Medicine and Psychiatry (July/August)
  • Generic Medications in Psychiatry (June)
  • The Treatment of Eating Disorders (May)
  • Healthcare Policy and Psychiatry (April)
  • Antipsychotic Roundup 2009 (March)
  • Psychiatric Medication in Pregnancy and Lactation (February)
  • Transcranial Magnetic Stimulation (January)

2008

  • Treating Fibromyalgia and Pain in Psychiatry (December)
  • Issues in Child Psychiatry (November)
  • Improving Psychiatric Practice (October)
  • Treating Personality Disorders (September)
  • Bipolar Disorder (July/August)
  • Antipsychotic Roundup 2008 (June)
  • Atypical Antipsychotics in Clinical Practice (February)
  • Neuropsychological Testing (May)
  • Psychiatric Medications: Effects and Side Effects (April)
  • Update on Substance Abuse (March)
  • Anticonvulsants in Psychiatry (February)
  • Brain Devices in Psychiatry (January)

2007

  • The Treatment of Insomnia (December)
  • Avoiding Malpractice in Psychiatry (November)
  • Update on Eating Disorders (October)
  • Complex Psychopharmacology (September)
  • Laboratory Testing in Psychiatry (August)
  • Psychotherapy in Psychiatry (July)
  • Posttraumatic Stress Disorder (June)
  • Topics in Geriatric Psychiatry 2007 (May)
  • Pregnancy and Menopause in Psychiatry (Apil)
  • Antipsychotic Roundup 2007 (March)
  • Understanding Psychiatric Research (February)
  • Antidepressant Round-up 2007 (January)

2006

  • Technology and Psychiatric Practice (December)
  • The Use of MAOIs (November)
  • Medication Treatment of Depression (January)
  • Seasonal Affective Disorder (October)
  • Treatment of ADHD (September)
  • Topics in Bipolar Disorder (August)
  • Neurotransmitters in Psychiatry (July)
  • Treating Substance Abuse (June)
  • The STAR*D Antidepressant Trial (May)
  • Natural Treatments in Psychiatry (April)
  • Medication Treatment of Anxiety (March)
  • Panic Disorder: Making Treatment Work (March)
  • Antipsychotic Roundup 2006 (February)
  • Antidepressant Roundup 2006 (January)

2005

  • Self-Help Books and Psychiatry (December)
  • Genetics and Psychiatry (November)
  • Pregnancy and Psychiatric Treatment (October)
  • Benzodiazepines and Hypnotics in Psychiatry (September)
  • Geriatric Psychiatry Update (August)
  • Chart Documentation in Psychiatry (July)
  • The Treatment of Bipolar Disorder (June)
  • Weight Loss and Smoking Cessation in Psychiatry (May)
  • Treating ADHD (April)
  • Drug Industry Influence in Psychiatry (March)
  • Atypical Antipsychotics 2005 (February)
  • Antidepressant Roundup 2005 (January)

2004

  • Sexual Dysfunction (December)
  • Suicide Prevention (November)
  • To Sleep, To Awake (October)
  • Women’s Issues in Psychiatry (September)
  • OCD: An Update (August)
  • Chronic Pain and Psychiatry (July)
  • Neuroimaging in Psychiatry (June)
  • Natural Medications in Psychiatry (May)
  • Posttraumatic Stress Disorder (April)
  • Treatment of Alcoholism (March)
  • Battle of the Atypicals (February)
  • Antidepressant Roundup, 2004 (January)

2003

  • Research Methods in Psychiatry (December)
  • Antidepressants in Children (November)
  • The Treatment of Dementia (October)
  • Bipolar Disorder, Part II: The Novel Anticonvulsants (September)
  • Bipolar Disorder: The Basics (August)
  • Drug-Drug Interactions in Psychiatry (July)
  • Managing Antidepressant Side Effects (June)
  • Antidepressants in Pregnancy and Lactation (May)
  • ADHD: Medication Options (April)
  • Panic Disorder: Making Treatment Work (March)
  • Atypical Antipsychotics in Clinical Practice (February)
  • Medication Treatment of Depression (January)

2019

  • Autism in Children and Adolescents (November/December)
  • Depression in Children and Adolescents (May/June/July/August)
  • Substance Use in Children and Adolescents (September/October)
  • Trauma in Children and Adolescents (March/April)
  • Anxiety in Children and Adolescents (January/February)

2018

  • Psychotropic Risks in Children and Adolescents (May/June)
  • ADHD in Children and Adolescents (November/December)
  • Depression in Children and Adolescents (September/October)
  • Autism in Children and Adolescents (July/August)
  • Anxiety in Children and Adolescents (March/April)
  • Suicide in Children and Adolescents (January/February)

2017

  • Adolescents (November/December)
  • ADHD in Children and Adolescents (September/October)
  • Psychosis in Children and Adolescents (August)
  • PANDAS, PANS, and Related Disorders (June/July)
  • Marijuana in Children and Adolescents (May)
  • Tourette’s and Other Tic Disorders in Children and Adolescents (March/April)
  • Autism in Children and Adolescents (January/February)

2016

  • Gender Dysphoria in Children and Adolescents (November/December)
  • Technology Issues With Children and Adolescents (September/October)
  • Mood Dysregulation in Children and Adolescents (July/August)
  • Eating Disorders in Children and Adolescents (May/June)
  • Conduct Disorder in Children and Adolescents (April)
  • Sleep Disorders in Children and Adolescents (March)
  • ADHD in Children and Adolescents (January/February)

2015

  • Antidepressant Use in Children (November/December)
  • Foster Care and Child Psychiatry (September/October)
  • Autism (July/August)
  • Trauma (May/June)
  • Anxiety Disorders (April)
  • Schools and Psychiatry (March)
  • Emergency Psychiatry in Children (January/February)

2014

  • Antipsychotics in Children (December)
  • ADHD (November)
  • Gender and Sexuality (September/October)
  • Psychotic Symptoms (Summer)
  • Medication Side Effects (May)
  • Food and Mood (April)
  • Learning and Developmental Disabilities (February)

2013

  • Complex Practice Issues (December)
  • Diet and Nutrition (November)
  • Child Psychiatry in DSM-5 (August/September)
  • Medication Side Effects and Interactions (June/July)
  • Problematic Technology (March/April)
  • Autism Spectrum Disorders (January/February)

2012

  • Bipolar Disorder (December)
  • Substance Abuse (October/November)
  • Transitional Age Youth (July/August)
  • Rating Scales (May/June)
  • Eating Disorders (March/April)
  • Behavioral Disorders (February)

2011

  • Treatment of Anxiety Disorders (December)
  • Trauma (November)
  • Bullying and School Issues (October)
  • Hidden Medical Disorders (August)
  • OCD and Tic Disorders (June)
  • Suicide and Non-Suicidal Self Injury (April)
  • Sleep Disorders (March)
  • ADHD (January)

2010

  • Use of Antipsychotics in Children and Adolescents (December)
  • Learning and Developmental Disabilities (October)
  • Major Depression (September)
  • Treating Children and Families (July)
  • The Explosive Child (May)

2019

  • Dual Diagnosis in Addiction Medicine (May/June)
  • Medical Issues in Addiction Practice (November/December)
  • Alcohol Addiction (September/October)
  • Legal Issues in Addiction Medicine (July/August)
  • Traumatic Brain Injury and Addiction (March/April)
  • Board Certification in Addiction Medicine (January/February)

2018

  • Opioid Addiction (November/December)
  • Addiction in Older Adults (October)
  • Sleep Disorders and Addiction (September)
  • Adolescent Addiction (July/August)
  • Pain and Addiction (May/June)
  • Cannabis and Addiction (March/April)
  • Stigma and Addiction (January/February)

2017

  • Pregnancy and Addiction (November/December)
  • Detox (Sepember/October)
  • Dual Diagnosis (August)
  • Alternatives to 12-Step Programs (June/July)
  • Recovery (May)
  • Psychiatric Uses of Street Drugs (March/April)
  • Sex Addiction (January/February)

2016

  • Prescription Drug Monitoring Programs (PDMPs) (November/December)
  • Addiction in Health Care Professionals (September/October)
  • Dialectical Behavior Therapy in Addiction (August)
  • Motivational Interviewing (June/July)
  • Benzodiazepines (May)
  • Opioid Addiction (March/April)
  • Families and Substance Abuse (January/February)

2015

  • The Twelve Steps (November/December)
  • Designer Drugs (September/October)
  • Residential Treatment Programs Decoded (July/August)
  • Nicotine and E-Cigarettes (June)
  • Drug Screening (April/May)
  • Integrating Therapy and Medications for Alcoholism (March)
  • Detoxification Protocols (January/February)

2014

  • Behavioral Addictions (December)
  • Risk and Reimbursement (November)
  • Stimulant Abuse (September/October)
  • Self-Help Programs (June)
  • Opioid Addiction (May)
  • Coping with Bad Outcomes (March)
  • Change Management in Addiction Treatment (January/February)

2013

  • Cocaine Addiction (December)
  • Relapse Prevention (November)
  • Cannabis Addiction (August/September)
  • Addiction in DSM-5 (June/July)
Editor-in-Chief

Chris Aiken, MD

Dr. Aiken is the 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. 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.

Full Editorial Information

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Subscriptions
  • Books
  • Online Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Child Psychiatry Report

Contact

  • info@thecarlatreport.com
  • 866-348-9279
  • PO Box 626, Newburyport MA 01950

Follow Us

© 2021 Carlat Publishing, LLC and Affiliates, All Rights Reserved.

Please see our Privacy Policy and the Hardware/Software Requirements to view our website.

×