Anxiety Carlat Reports | Carlat Publishing

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

Quetiapine Reconsidered

From The Carlat Psychiatry Report, Psychotic Depression

It is the best of drugs; it is the worst of drugs. Quetiapine (Seroquel) has benefits in some disorders that are unmatched by other medications, but it is also one of the most difficult antipsychotics to tolerate. In this article, I’ll look at where this medication fits and whether its numerous off-label uses are justifiable, including PTSD, generaliz

Expert Q&A

Benzodiazepines: A Reevaluation of Their Benefits and Dangers

From The Carlat Psychiatry Report, Psychotic Depression

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Hypnotics

TCPR: Benzodiazepines were the most commonly prescribed drug—of all drugs—in the 1970s. Are they still that popular? Dr. Salzman: I think benzodiazepines are still widely used, both appropriately and inappropriately. The SSRIs were supposed to replace the benzos for long-term treatment of anxiety, but while the use of these antidepressants has in

Uncommon Tips

Uncommon Tips: Which Is Better—Citalopram or Escitalopram?

From The Carlat Psychiatry Report, Psychotic Depression

Topics: Anxiety | Citalopram | Depression | Escitalopram | SSRIs

Editor’s note: We’re pleased to introduce the new feature “Uncommon Tips.” In this series, Dr. Aiken will discuss little-known pearls about commonly used medications. The series starts with a comparison of citalopram and escitalopram. The rivalry between these two SSRIs began in 2002 when the Lundbeck pharmaceutical company split citalopram (

Clinical Update

Deprescribing Anti-Anxiety Medications in Older Adults

From The Carlat Geriatric Psychiatry Report, Anxiety

Our inclination may be to “not rock the boat” when a patient is stable and not misusing prescribed medication. However, tapering anti-anxiety medications in older adults is often a good idea when considering the risks of falls, sedation, and accidents. Which meds to taper? The risks of anti-anxiety medications increase with age. Here are some of t

Expert Q&A

Benzodiazepines in Older Adults

From The Carlat Geriatric Psychiatry Report, Anxiety

CGPR: When do you start benzodiazepines in older adults? Dr. Aiken: The best evidence for benzodiazepines in the elderly is in panic disorder, followed by phobias, social anxiety disorder, and generalized anxiety disorder. Benzodiazepines are also the mainstay of treating catatonia, rapid eye movement sleep behavior disorder, and alcohol withdrawal. Ho

Expert Q&A

An Update on Neuromodulation Techniques for Older Adults

From The Carlat Geriatric Psychiatry Report, Anxiety

CGPR: One of the more interesting neuromodulation interventions is magnetic seizure therapy (MST). How does it work? Dr. Lisanby: MST is an investigational form of treatment for depression. Similar to electroconvulsive therapy (ECT), MST induces seizures with the intention of therapeutic benefit, but the big difference between MST and ECT is how the se

Research Update

SSRIs vs SNRIs in Pediatric Anxiety Disorders: Which Are More Tolerable?

From The Carlat Child Psychiatry Report, Substance Use in Children and Adolescents

REVIEW OF: Mills JA and Strawn JR, J Am Acad Child Adolesc Psychiatry 2020;59(11):1240–1251 STUDY Type: Meta-analysis For children with anxiety disorders and OCD, SSRIs produce faster and greater improvement than SNRIs (Strawn JR et al, J Am Acad Child Adolesc Psychiatry 2018;57(4):235–244.e2). Unfortunately, adverse effects slow down our dose

Research Update

Heart Rate Changes Linked to Emotional Dysregulation

From The Carlat Child Psychiatry Report, Autism in Children and Adolescents

Review of: Deutz MH et al, J Am Acad Adolesc Psychiatry 2019;58(6):589–599 Can we use heart rate to assess and track psychopathology? Child psychiatrists associate lower resting heart rate (HR-rest) and heart rate reactivity (HR-reactivity) with externalizing behaviors such as disruptive behaviors and aggression (“under-arousal”) and elevations

Research Update

Prescribing Patterns for Children With Anxiety Disorders

From The Carlat Child Psychiatry Report, Depression in Children and Adolescents

Review of: Bushnell GA et al, J Clin Psychiatry 2018;79(1):pii:16m11415 Anxiety disorders are some of the most common conditions we encounter in children and adolescents, and clinicians employ a variety of medications to treat them. This study examined prescribing patterns for the initial treatment of pediatric anxiety. Researchers analyzed a larg

Clinical Update

The “Z-Drugs”: Safety Issues and Misuse Potential

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Originally marketed as safer alternatives to benzodiazepines, the Z-drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—were considered devoid of misuse potential. But recent data and FDA warnings suggest we’ve been hitting the snooze on them for too long. Here, we review their risks and discuss safe prescribing. Medical risks

Expert Q&A

Benzodiazepines: Old Medicines, New Concerns

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

CATR: To begin, tell us about the research and clinical work you do. Dr. Morford: I am an assistant professor at the Yale School of Medicine in the Program of Addiction Medicine. I trained as a general internist, and I see patients primarily at a large opioid treatment program and in an inpatient setting on an addiction consult service. I’m involved

Expert Q&A

Thyroid Augmentation in Bipolar Disorder

From The Carlat Psychiatry Report, Thyroid and Mental Illness

TCPR: When do you use thyroid augmentation in bipolar disorder?Dr. Kelly: It may be useful for treatment-resistant bipolar depression, and I emphasize treatment-resistant because that is where the empiric support lies. Now, the evidence is not rock-solid, but when it comes to treatment-resistant bipolar depression we don’t have much else to draw on ex

In-Brief

A Longer Acting Lorazepam

From The Carlat Psychiatry Report, Living With Mental Illness

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | extended-release | Sleep

Lorazepam (Ativan) received a new coating this year as Loreev XR, which promises a 24-hour duration for this benzodiazepine that is otherwise divided in two or three daily doses. It joins alprazolam (Xanax) as the only benzos with extended-release (XR) formulations (clorazepate ventured into this territory as Tranxene SD in 2002, but that medication is

Clinical Update

An Off-Label Guide to Gabapentin

From The Carlat Psychiatry Report, Schizophrenia

Gabapentin (Neurontin) is not a medication that would make the FDA proud. Less than 1% of its outpatient use is for an FDA indication, and a good portion of the off-label use takes place in psychiatry. These trends sparked a backlash in the 2000s, when Pfizer paid a $1.3 billion fine for misleading marketing practices. Recent reports of misuse of gabape

Clinical Update

Buspirone: Still Effective After All These Years?

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

When buspirone was released in 1986, it was advertised as providing “a different kind of calm.” Unfortunately, physicians and their patients weren’t ready to accept the kind of calm that required several weeks to take effect, when punchier, quicker benzos were the standard route to tranquility. Although buspirone is FDA approved for generalized an

Research Update

Rest Easy: Benzos, Z-Drugs, and Dementia

From The Carlat Psychiatry Report, Mind-Gut Connection

Review of: Osler M and Jorgensen MB, Am J Psych 2020;177(6):497–505 Study TYPE: Epidemiologic case-control Few psychotropics stir controversy like the benzodiazepines. While they work well for anxiety and insomnia, their risks of abuse and dependence have always nagged at us. More recently, some research has suggested that long-term use increase

Clinical Update

Silexan: A Novel Anxiolytic

From The Carlat Psychiatry Report, Traumatic Brain Injury

Patients with generalized anxiety disorder (GAD) often look to medications for help, but GAD is one of the disorders where medications are likely to disappoint. Effect sizes tend to fall in the small range (0.2–0.3) with meds for GAD, including SSRIs, SNRIs, buspirone, and pregabalin (Lyrica). Only the benzodiazepines have an effect in GAD that’s bi

Ask The Editor

Is Paxil the Best SSRI for Anxiety?

From The Carlat Psychiatry Report, How to Talk about Medication

Dear Dr. Aiken: Your review of Paxil’s risks in the May issue failed to mention a benefit that’s unique to this drug. Isn’t it the best SSRI for anxiety? Dr. Aiken: Paroxetine’s (Paxil’s) reputation as the anti-anxiety SSRI got off to a running start. It was first launched for panic disorder in 1996, two years before its approval for depres

Expert Q&A

Building Self-Regulation in Children

From The Carlat Child Psychiatry Report, Trauma in Children and Adolescents

Topics: Anxiety | Child Psychiatry | Self-Regulation

“Self-regulation” has become a buzz phrase to help children manage stress, become resilient, and stave off depression, anxiety, and post-traumatic stress disorder. To gain a better understanding of this concept, we interviewed Stuart Shanker, PhD, founder and CEO of the MEHRIT Centre (https://self-reg.ca). Dr. Shanker sets up self-regulation program