Antidepressants Carlat Reports

Research Update

Does Childhood Maltreatment Reduce Response to Antidepressant Treatment?

From The Carlat Psychiatry Report, College Mental Health

Topics: Antidepressants | child abuse | Trauma

Brian Miller, MD, PhD, MPH. Dr. Miller, author of this educational activity, receives research support from Augusta University; the National Institute of Mental Health; the Brain and Behavior Research Foundation; and the Stanley Medical Research Institute. Relevant financial relationships listed for the author have been mitigated. REVIEW OF

Clinical Update

What Gets in the Way of Antidepressants?

From The Carlat Psychiatry Report, ADHD

When patients don’t respond to an antidepressant, it’s a good idea to step back and look for anything that might be getting in the way. Major stress, substance use, medication nonadherence, anxiety, and medical and psychiatric comorbidities are high on that list, but recent research has added more possibilities that we’ll review in this article.

Clinical Update

Tricyclic Antidepressants: When and How to Use Them

From The Carlat Psychiatry Report, Race and Mental Health

Topics: Antidepressants | Dosing | Side Effects | Treatment-Resistant Depression | Weight gain

Tricyclics have been used in psychiatry since the 1950s, when imipramine was introduced as the first mass-marketed antidepressant. Fluoxetine and the other SSRIs largely supplanted the tricyclics in the 1990s, but these medications still have their uses. There are two kinds of tricyclics: Tertiary amines—the “originals” Secondary amines—t

Expert Q&A

Duty to Warn? Debating Antidepressant Suicidality

From The Carlat Child Psychiatry Report, Mood Disorders in Children and Adolescents

Topics: adolescents | Antidepressants | children | Depression | emergent suicidality

CCPR: We are here with Dr. Ignaszewski and Dr. Spielmans to review the latest on emergent suicidality in children and adolescents during antidepressant treatment. Dr. Spielmans, please give us the context of this issue and how your recent article fits in (Spielmans GI, Spence-Sing T, and Parry P, Front Psychiatry 2020;11:18). Dr. Spielmans: In 2004, th

Research Update

Which Medications Have the Lowest Risk of Side Effects?

From The Carlat Child Psychiatry Report, Mood Disorders in Children and Adolescents

REVIEW OF: Solmi M et al, World Psychiatry 2020;19(2):214–232 Adverse effects are important considerations when choosing psychotropic medications, especially in children and adolescents. This study pooled available research to compare the safety profiles of various psychotropics used in the pediatric population. The authors screened thousands of st

Article

Antidepressants in Bipolar Disorder: The Controversy Continues

From The Carlat Psychiatry Report, The Treatment of Bipolar Disorder

Topics: Antidepressants | Bipolar Disorder

There is a battle underway in the genteel circles of academic psychiatry. The disputed question is: Are antidepressants (ADs) good or bad for patients with bipolar disorder? The major figureheads in this drama are respected psychiatrists on opposite coasts. In the pro-AD corner, weighing in with an endowed chair and full professorship at UCLA, we hav

Article

Cymbalta: Dual the Reuptake, Triple the Hype

From The Carlat Psychiatry Report, Antidepressant Roundup, 2004

Topics: Antidepressants

We have some good news and we have some bad news. First, the good news: Cymbalta (generic name: duloxetine) is an effective dual reuptake antidepressant with a good safety profile. Now, the bad news: it appears to have no advantages over existing antidepressants. Of course, this is not exactly the impression you'll be getting from Lilly-sponsored art

Article

ECT: The Very Latest

From The Carlat Psychiatry Report, Antidepressant Roundup, 2004

Topics: Antidepressants

Whether you do ECT (electroconvulsive therapy) or not, and research indicates that less than 8% of you actually perform it (Hermann et al, Am J Psychiatry 1998; 155:889-894), you need to know about it, because you will have to decide when to refer your treatment-resistant patients for it, and you will have to know what to say to them about it as they pe

Article

Antidepressant Updates

From The Carlat Psychiatry Report, Antidepressant Roundup, 2004

Topics: Antidepressants

Sorry, no earthshaking developments in the antidepressant world in 2003, but here are some developments that you’ll find useful in your practice. Coming soon. Symbiax. Or so say the ads, indicating that it is on the verge of FDA approval. Brought to you by Eli Lilly, it is a combination of Prozac and Zyprexa. The word on the street is that it will

Expert Q&A

Dr. John O’Reardon on Antidepressant Augmentation

From The Carlat Psychiatry Report, Antidepressant Roundup, 2004

Topics: Antidepressants

TCR: Dr. O'Reardon, you had mentioned at the end of our last interview (see TCR, Vol. 1, No. 1) some of the augmentation and combination strategies that you like to use in your clinic but we didn't have time to get into the actual specifics of these. To begin with, how do you decide when to augment? What kinds of drug failures do you try to establish?

Article

Do Antidepressants Beat Placebo?

From The Carlat Psychiatry Report, Research Methods in Psychiatry

Topics: Antidepressants

In case you haven't noticed, antidepressants are under attack. Articles such as "The Emperor's New Drugs" and popular books like "Prozac Backlash" point to a growing public sentiment that psychiatrists need to shed a little hubris. Some of these attacks are little more than sensationalist accounts of problems we are well aware of, such as the SSRI wi

Article

Do Antidepressants Work for Kids?

From The Carlat Psychiatry Report, Antidepressants in Children

Topics: Antidepressants | Child Psychiatry

What a bind we seem to be in. On the one hand, we are short several thousand child psychiatrists in the United States, and parents are beating down our (generalist) doors to get their children medicated. On the other hand, every other piece of news about childhood psychopharmacology seems either bad or lukewarm. In this issue, TCR takes a stab at

Article

Breast-feeding and Antidepressants: An Update

From The Carlat Psychiatry Report, Antidepressants in Pregnancy and Lactation

Topics: Antidepressants | Pregnancy | SSRIs

There’s nothing like a close friend suffering psychiatric difficulties to motivate a psychiatrist to do some serious reading. Recently, your humble editor encountered this situation. The patient is a young woman with no psychiatric history who noted more than a normal amount of anxiety after the birth of her child. She found herself worrying consta

Expert Q&A

Dr. Victoria Hendrick on Using Meds in Pregnancy

From The Carlat Psychiatry Report, Antidepressants in Pregnancy and Lactation

Topics: Antidepressants | Pregnancy | SSRIs

TCR: Dr. Hendrick, there has been a lot of confusing and seemingly contradictory data about the safety of SSRIs during pregnancy. What’s your take? Dr. Hendrick: You’re right, it is confusing, but one reassuring and important point is that there is no evidence that the SSRIs or any other antidepressant are linked to an increased risk of congenital

Anecdotes From The Field

An OB/GYN Perspective

From The Carlat Psychiatry Report, Antidepressants in Pregnancy and Lactation

Topics: Antidepressants | Pregnancy | SSRIs

Roseann Gumina, M.D., is an obstetrician/gynecologist in private practice in Milwaukee, Wisconsin. Like most OB/GYNs, Dr. Gumina sees more pregnant women on antidepressants in a given year than most psychiatrists are likely to see in a lifetime, and her perspective is informative. “Generally, most women who have been on SSRIs will have already disc

Research Update

Can Buprenorphine Improve PTSD Symptoms?

From The Carlat Addiction Treatment Report, Legal Issues in Addiction Medicine

Review of: Lake EP et al, Am J Addict 2019;28(2):86–91 For many years, the mainstay of treatment for PTSD has been the SSRI class of medications, but many of our patients still suffer crippling symptoms despite optimal antidepressant medication dosing. PTSD is often accompanied by opioid misuse, sometimes in an effort to self-treat the hyperarousal

Article

Treating Sexual Side Effects

From The Carlat Psychiatry Report, Depression

Topics: Antidepressants | Sexual Side Effects | SSRIs

Sexual side effects on SSRIs are so common that psychiatrist David Healy once argued these drugs more reliably lower libido than treat depression. Yet the problem isn’t limited to SSRIs, and it’s not unmanageable. In this article, I’ll look at some useful strategies to manage sexual dysfunction on antidepressants, antipsychotics, and mood stabiliz

Expert Q&A

An Antidepressant Diet

From The Carlat Psychiatry Report, Depression

Topics: Antidepressants | Depression | Nutrition | Registered Articles

TCPR: A few years ago, your group conducted the first clinical trial of diet on depression. Where did you get the idea for that? Dr. Jacka: We had a decade of observational evidence linking the quality of people’s diets to their risk for depression. Those findings were pretty consistent across countries, cultures, and age groups: A healthy diet is

Expert Q&A

Getting Uncomfortable with Esketamine

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