• Subscribe
  • Register for free Content
  • Cart
  • Login
  • Browse by Topic
    • Acamprosate
    • Addiction
    • Addiction Treatment
    • Addyi
    • Adhansia XR
    • ADHD
    • adolescents
    • Adult ADHD
    • Agitation
    • Akathisia
    • Alcohol
    • Alcohol Use
    • Alcohol use disorder
    • Alcoholism
    • Alternative treatments
    • amphetamine
    • Amphetamines
    • Anorexia Nervosa
    • Antidepressant Augmentation
    • Antidepressants
    • Antipsychotic
    • Antipsychotics
    • Anxiety
    • Anxiety Disorder
    • Aripiprazole
    • Asenapine
    • Assessment
    • attention
    • Attention Deficit Hyperactivity Disorder
    • Atypical Antipsychotics
    • Autism
    • Autism Spectrum Disorder
    • Autism Spectrum Disorder
    • Behavior therapy
    • Benzodiazepines
    • Bipolar Depression
    • Bipolar Disorder
    • Board Certification
    • Brain Devices
    • Brief psychotherapy
    • Bullying
    • Buprenorphine
    • Bupropion
    • Caffeine
    • CAM Treatments
    • Cannabidiol
    • Cannabis
    • Chantix
    • Child Psychiatry
    • Child Psychiatry
    • children
    • Clinical practice
    • CME Post-Test
    • Co-occurring disorders
    • Cognition
    • Cognitive Behavioral Therapy
    • Cognitive Decline
    • Cognitive Rehabilitation Therapy (CRT)
    • Collaborative care
    • Comorbidity
    • Complementary treatments
    • Complimentary treatments
    • Computers in Psychiatric Practice
    • Conduct Disorder
    • Confidentiality
    • Connect
    • Connection
    • Contagion
    • Cosmetic pharmacology
    • Crocus Sativus
    • Cultural Competence
    • Cymbalta
    • Dementia
    • Deplin
    • Deprescribing
    • Depression
    • Depressive Disorder
    • Diagnosis
    • Diagnostic Testing
    • DSM
    • Dual diagnosis
    • Duloxetine
    • Dysregulation
    • Eating Disorders
    • eCigarettes
    • Effexor
    • efficacy
    • Emotional dysregulation
    • End of Life Care
    • Engagement
    • Esketamine
    • eTNS
    • Existing marijuana
    • extended-release
    • Falls
    • Family Separation
    • FDA Warnings
    • Female hypoactive sexual desire disorder
    • Female Issues in Psychiatry
    • Folate
    • Folic Acid
    • Free Articles
    • Gender & Sexuality
    • Gender Dysphoria
    • Generalized Anxiety Disorder
    • GeneSight
    • Genetic Testing
    • Genetics and Psychiatry
    • Geriatric Psychiatry
    • Hair loss
    • Head Trauma
    • Health Apps
    • Heart rate
    • Hepatitis
    • HIPAA
    • Histamine
    • HIV
    • Hypnotics
    • Incarceration
    • Inflammation
    • inquiry
    • Insomnia
    • Intervention
    • Irritability
    • Ketamine
    • l-methylfolate
    • Laboratory Testing in Psychiatry
    • Learning & Developmental Disabilities
    • Light and Dark Therapy
    • Light therapy
    • Lightbox
    • Lithium
    • Low libido
    • Lyrica
    • Mania
    • Marijuana
    • Media
    • Medical Comorbidities
    • Medication
    • Medication adherence
    • Methadone
    • methylfolate
    • methylphenidate
    • Micronutrients
    • Mirtazapine
    • Mood Stabilizers
    • Motivational Interviewing
    • Naloxone
    • Naltrexone
    • Narcolepsy
    • Natural Medications
    • natural treatments
    • Neurology
    • Neuroscience in Psychiatry
    • Neurotoxicity
    • News of Note
    • Nightmares
    • Novel Medications
    • Nutrition
    • OCD
    • olanzapine
    • Opioid epidemic
    • Opioid Use Disorder
    • Opioids
    • Orthostasis
    • Outpatient
    • Overdose
    • Pain
    • Panic Disorder
    • Parenting Strategies
    • Patch
    • Patient relationship
    • pediatric
    • Personality Disorders
    • Pharmaceutical Industry
    • Pharmacology
    • Pharmacology Tips
    • PICOT
    • Pitolisant
    • Postpartum Depression
    • Potency
    • Practice Tools and Tips
    • Practice Tools and Tips
    • Prazosin
    • Pregabalin
    • Pregnancy
    • prescribing patterns
    • Prevention
    • Primary care
    • Prison
    • Prolonged exposure
    • Psychiatric interviewing
    • Psychopharm Myths
    • Psychopharmacology
    • Psychopharmacology Tips
    • Psychosis
    • Psychotherapy
    • Psychotherapy
    • PTSD
    • Registered Articles
    • Research
    • Research Update
    • Research Updates
    • Retirement
    • Risk
    • Risk Management
    • Risperidone
    • Ritalin
    • safety
    • Saffron
    • Saphris
    • Schizophrenia
    • School Refusal
    • Seasonal Affective Disorder
    • Secuado
    • Self-Regulation
    • Sex Therapy
    • Sexual Dysfunction
    • Sexual Side Effects
    • Side Effects
    • Sleep
    • Sleep Apnea
    • Sleep Disorders
    • Smoking Cessation
    • Smoking Cessation Agents
    • Social Anxiety Disorder
    • SSRIs
    • steroids
    • stimulant
    • Suboxone
    • Substance Abuse
    • Substance Abuse
    • Substance Use
    • Substance Use Disorder
    • Substance use disorders
    • Suicidality
    • Suicide
    • Symptom Assessment
    • Symptom Management
    • Technology
    • teens
    • test cme quiz
    • Therapy during medication appointment
    • Therapy with Med Management
    • TMS
    • Tobacco
    • Transcranial Magnetic Stimulation
    • Transdermal
    • Trauma
    • Traumatic Brain Injury (TBI)
    • treatment
    • treatment pediatric
    • Treatment planning
    • Treatment-Resistant Depression
    • Trigeminal Nerve Stimulation
    • Understanding Psychiatric Research
    • Vaping
    • Varenicline
    • Venlafaxine
    • 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
  • HOME
  • STORE
  • CME CENTER
  • Blog
  • NEWSLETTERS
    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
  • Archive
  • Archive
  • Archive
  • The Carlat Psychiatry Report
  • Biomarkers in Psychiatry (May)
  • The GeneSight Genetic Test: A Review of the Evidence

The GeneSight Genetic Test: A Review of the Evidence

The Carlat Psychiatry Report, Volume 13, Number 5, May 2015
https://www.thecarlatreport.com/newsletter-issue/tcprv13n5/

From The Carlat Psychiatry Report, May 2015, Biomarkers in Psychiatry

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

Topics: Diagnostic Testing | Genetics and Psychiatry | Pharmaceutical Industry | Practice Tools and Tips

Print Friendly, PDF & Email

Daniel Carlat, MD

Editor-in-Chief, Publisher, The Carlat Report.

Dr. Carlat has disclosed that he has no relevant relationships or financial interests in any commercial company pertaining to this educational activity.

Assurex Health recently sent me an email inviting me to dine at Legal Seafood to learn about “Clinical Applications of Psychiatric Pharmacogenetics.” I didn’t go, but increasingly I am hearing from colleagues about their experiences at these dinner programs: “What do you think about this GeneSight test? The data looked pretty impressive at this dinner.”

Clearly, the field of pharmacogenetic testing is growing up when companies can afford this kind of promotional money nation-wide. There are now several companies marketing such tests—including Assurex, Genomind, Genelex and others.

We covered this topic last fall (TCPR, October 2014) and concluded that there was not enough good evidence for using genetic testing in routine practice. In the following, I’ll zero in specifically on GeneSight to review the data—so that you’ll be more informed if you choose to dine courtesy of Assurex. Good food and wine tend to dull your critical faculties, and you don’t want a company to hypnotize you into adopting a very expensive test unless it will really help your patients.

The Context of Pharmacogenetic Testing

Humans vary genetically—not only in eye and hair color but in more obscure ways, such as how we metabolize drugs. While the majority of our patients metabolize drugs normally, a small percentage do not. Using the most important enzyme, 2D6, as a benchmark, roughly 5–10% of Caucasians are poor metabolizers, and 1% are ultra-rapid metabolizers (Ingelman-Sundberg, M, Pharmacogenomics J 2005;5(1):6–13). Of the remainder, the majority are “extensive” (or normal) metabolizers. You should know that these frequencies vary among ethnic groups—for example, only about 1% of Asians are slow metabolizers.

Before I discuss GeneSight, an important but often overlooked point is that the recent GeneSight studies were preceded by decades of disappointing clinical studies in this field. Two large reviews of the literature on pharmacogenetics in mood disorders—one in 2007 (Genet Med 2007;9(12):819–825) and one in 2013 (CNS Spectr 2013;18(5):272–284)—could find no association between metabolizer status and response of depressed patients to SSRIs. Tricyclics are a different story, with evidence-based guidelines recommending dosage adjustments based on P450 testing (Hicks JK et al, Clin Pharmacol Ther 93(5):402–408, 2013). But most psychiatrists are not using the new genetic tests for tricyclics, which we rarely prescribe.

The take home point is that there’s a long history of negative or inconclusive studies in the field—so GeneSight’s evidence had better be pretty convincing before we decide to change our clinical practice based on it.

The GeneSight Test

The basic GeneSight test as evaluated in their clinical trials analyzes patient DNA for genes encoding three metabolic enzymes and two serotonin-related proteins. The three enzymes are 2D6, 2C19, and 1A2—all of which are located in the liver and are involved in metabolizing various medications. The other two molecules are SLC6A4 (the serotonin transporter gene) and HTR2A (the serotonin 2A receptor gene). (GeneSight has expanded its testing panel since the clinical trials—you can find the current list on its website, www.genesight.com).

The metabolic enzymes are clearly relevant for metabolism—no surprises there. But why did they include the serotonin genes in the assay? Presumably because they can theoretically affect the antidepressant response. However, there’s no scientific consensus that we have found the right genes yet. The most definitive meta-analysis found no consistent evidence of a relationship between serotonin genes and response to any antidepressant (Am J Psychiatry 2013;170(2):207–217). So GeneSight’s adding these genes appears to serve little use other than to make their assay appear more robust than a simple test of P450 enzymes.

The testing process is quite simple: you use cotton cheek swabs to collect the DNA, the samples are overnighted to Assurex, and results are provided within 36 hours. As a doctor, you’ll be sent a report classifying a list of 38 psychiatric drugs into three possible categories: green bin (“use as directed”), yellow bin (“use with caution”) and red bin (“use with caution and with more frequent monitoring”). An easy example is Paxil, which is metabolized primarily by 2D6. Paxil will presumably show up in the red bin in two cases: if your patient is a poor metabolizer (because Paxil doses could go too high) or if he is an ultra-rapid metabolizer (the dose could be too low).

It all makes sense theoretically. But what about in actual practice?

The GeneSight Evidence

Three clinical studies have been conducted thus far. See the chart on this page for a brief summary of the main findings. There have been two open label studies, and one randomized, “double-blind” study (I’ll explain why I put quotes around that in a second). The methods of the studies are similar. Patients who are taking medications for depression are recruited from a clinic. They are assigned to one of two groups. In the guided group, patients are given the GeneSight test, the prescriber sees the results, and is free to make changes in the patients’ meds based on the results of the test. In the unguided group, patients get the test, but the results are sealed until after the study is over. Patients are periodically evaluated with standard depression scales, and the study length was eight weeks in the open label trials, 10 weeks in the randomized trial. The main outcome is whether patients assigned to the guided group improve more than those assigned to the unguided group.

Open Label Results

The open label studies found a statistically significant effect of using GeneSight to guide treatment. Open label studies are easy to conduct, and they’re great for generating hypotheses, but we shouldn’t rely on them to make clinical decision. Remember gabapentin? Open label studies found it apparently effective for bipolar disorder—but subsequent double-blind studies did not.

GeneSight’s open label studies are vulnerable to various possible biases that might render the results meaningless. Here are some potential problems.

  • Patients were not assigned to groups randomly, but were chosen based on conversations with doctors and researchers. One potential source of bias: doctors may have preferentially assigned more complicated patients to the guided group on the theory that they would be most helped by genetic testing. If so, we wouldn’t really know if the results are applicable to all the patients we see, or just some undefined subset.
  • Patients assigned to the guided group knew they were getting a cutting-edge genetic test that could predict which medication would work best for them. Patients in the other group knew the test results would not be used for their treatment. Clearly, those in the guided group would be more optimistic about their treatment, which is a key component of the non-specific placebo effect.
  • Prescribers knew which patients were being guided by the test, potentially leading to the “cheerleader effect.”
  • The symptom raters knew which patients were in which group, potentially leading to biased ratings, since the raters may have vested interests in GeneSight being successful.

The bottom line is that the open label studies can tell us very little other than that GeneSight appears to have potential—and that it’s time to do the more expensive randomized double-blinded tests.

Randomized Results

The randomized double blind study was not “double” blind in the way drug trials are. The idea behind the double blind is that neither the researchers nor the patients know which group they are assigned to, so that there is no possibility of various biases or placebo effects creeping in. The GeneSight double blind study was blinded only to patients and symptom raters, and not to prescribers, who might have been cheerleading their patients to wellness.

Nonetheless, the results of that study showed a numerical superiority of guided treatment, but it was not statistically significant. For example, the difference in the Ham-D scores had a p value was 0.29—which means that there was a 29% chance that this difference was due to chance. The usual cut-off for statistical significance is 5%, so this result was not close to being significant. It’s possible that if they had recruited more patients, they might have found a significant difference. But for now we have to conclude that there is no convincing evidence that the GeneSight test helps us prescribe more effective medications for our patients

However, there is a bit of a silver lining for GeneSight in this study. In a subanalysis, the author focused on the 13 patients who entered the study taking antidepressants that were classified in the red bin—in other words, “use with caution and with more frequent monitoring.” Six of these were randomized to the guided group, and their doctors used the results to adjust the meds of all of these patients, who ended the study with a 33.1% Ham-D improvement. On the other hand, the seven patients who were assigned to the unguided group were less likely to have their meds changed, and they improved by only 0.8% on the Ham-D. This is intriguing, and raises the possibility that GeneSight might be useful for some patients. But remember—this is based on a subanalysis of 13 patients from an already tiny study.

Table 1: GeneSight Studies

Table: GeneSight Studies

Click here to open PDF

Bottom Line

If we were to hold the GeneSight test to the usual standards we require for making medication decisions, we’d conclude that there’s very little reliable evidence that it works. On the other hand, some of you will probably want to try it out, especially for those patients who have insurance that will cover the cost of the test. If you do order it, reserve it for patients who are most likely to benefit, including patients who have failed to respond to multiple medications (which could be caused by ultra-rapid metabolism, causing drug levels to be too low), and patients who have had lots of side effects (potentially caused by slow metabolism, causing drug levels to he too high).

Suggested Articles

  • Neurofeedback in Psychiatry: What’s the Evidence? April 1, 2018
  • Take The CME Post-Test for Dual Diagnosis, CATR, August 2017 August 1, 2017
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
The Medication Fact Book for Psychiatric Practice, Fifth Edition (2020)
Carlat Report Binders - Organize Your Print Copies
Psychiatry Practice Boosters, Second Edition (2018)
2019 Carlat Psychiatry Report Self-Assessment Course
The Child Medication Fact Book for Psychiatric Practice (2018)
Issue Archives

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)

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)

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

© 2019 Carlat Publishing, LLC and Affiliates, All Rights Reserved.

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