Antidepressant Augmentation Carlat Reports

Expert Q&A

From The Carlat Psychiatry Report, Esketamine

Esketamine (Spravato) was approved for treatment-resistant depression in 2019. In this interview, Dr. Williams (who has no relationship with Janssen Pharmaceuticals, Inc) addresses some lingering doubts that have been raised about the medicine. TCPR: Where does esketamine fit in the list of interventional therapies for depression, like repetitive tra

Article

Antipsychotic Maintenance: How Long is Enough?

From The Carlat Psychiatry Report, Esketamine

Your 58-year-old patient started risperidone to augment lithium 2 years ago. It got her out of a severe mania, and she has stayed well since then. Now she’s worried about long-term risks and wondering if it’s time to come off. Augmentation with an atypical antipsychotic may offer rapid relief from mania and depression, but antipsychotics’ potenti

Clinical Update

How to Prescribe Omega-3 Fatty Acids

From The Carlat Psychiatry Report, Living With Mental Illness

Omega-3 fatty acids (“fish oil”) claim broad benefits in physical and mental health and have even made it into a few treatment guidelines in psychiatry. But most products on the shelf do not have the right ingredients for psychiatric use. In this article, I’ll review how and when to use omega-3s. Mechanism Omega-3s are “essential fatty acids

Clinical Update

How to Use SAMe in Clinical Practice

From The Carlat Psychiatry Report, The Difficult Patient

S-adenosylmethionine (SAMe) is an over-the-counter supplement that’s usually lumped with the complementary and alternative (CAM) therapies in psychiatry. However, it is one of a few CAM therapies with efficacy that rivals standard medications. SAMe raises levels of serotonin, dopamine, and norepinephrine, acting in some ways like the fabled triple reu

Clinical Update

Light Therapy: Good for What Ails You?

From The Carlat Psychiatry Report, Mood Disorders

Topics: | | | | | | | | | | | | | | | | | ADHD Alternative treatments Antidepressant Augmentation Bipolar Depression Bulimia Nervosa Complementary treatments Complimentary Medicine Depression Depressive Disorder Light and Dark Therapy Light therapy Lightbox PTSD Seasonal Affective Disorder Sexual Dysfunction Sleep Sleep Disorders Traumatic Brain Injury (TBI)

There are several lifestyle changes with broad health benefits that we often encourage in our patients. Exercise, a healthy diet, sleep hygiene, and supportive social connections are near the top of the list, and bright daytime light might be worth adding. Light therapy is a standard treatment for seasonal affective disorder, and in this article we’ll

Research Update

Psilocybin vs Escitalopram for Depression

From The Carlat Psychiatry Report, Overdiagnosis

REVIEW OF: Carhart-Harris R et al, New Engl J Med 2021;384(15):1402–1411 STUDY TYPE: Randomized controlled trial Psilocybin is, among other things, a serotonin 2A agonist responsible for the psychedelic properties of magic mushrooms. Back in 1960, Sandoz (now Novartis) began marketing psilocybin to enhance the effects of psychotherapy, but produ

Clinical Update

ECT Worked: Now What?

From The Carlat Psychiatry Report, Therapy

Juan is a 72-year-old man with severe depression who has not responded to numerous antidepressant trials. He is reluctant to undergo a course of electroconvulsive therapy (ECT), but agrees to do so if one last medication trial doesn’t work. After failing to respond to escitalopram augmented with aripiprazole, Juan receives a course of ECT and has a te

Research Update

Antipsychotic Use Associated With Increased Risk of Mortality

From The Carlat Psychiatry Report, Stopping Psych Meds Part 2

Topics: Antidepressant Augmentation | Antipsychotics | Aripiprazole | Mortality

REVIEW OF: Gerhard T et al, PLoS One 2020;15(9):e0239206 TYPE OF STUDY: Population-based comparator cohort study We know that atypical antipsychotics increase mortality in elderly patients with dementia—the FDA has long required a black box warning to that effect. But are these medications also dangerous when prescribed to younger people with de

Expert Q&A

The Psychopharmacology Algorithm Project

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

TCPR: What would be the biggest change in practice if psychiatrists followed your algorithms?Dr. Osser: One area is bipolar depression. This is a disorder where there is an exceptionally large deviation between what the evidence says and what people are doing, especially when it comes to antidepressants. They are still being used rampantly, even in pati

Article

Mirtazapine Augmentation: Running Low on Rocket Fuel

From The Carlat Psychiatry Report, How to Talk about Medication

Adding mirtazapine (Remeron) to a serotonergic antidepressant is a popular augmentation strategy. When added to venlafaxine, the combo was thought to possess a particularly potent synergy that Stephen Stahl called “California Rocket Fuel.” However, the strategy has failed in a handful of new studies, some of them much larger than the original data.