Anxiety Disorder Carlat Reports

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

Clinical Update

Using Equine-Assisted Psychotherapy

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

Sylvia is 7 years old, referred for long-standing school refusal after CBT proved ineffective. You confer with her therapist about trying a different approach. When patients are not amenable to usual therapy, equine-assisted psychotherapy (EAP) might be a good option. In this article we’ll talk about working with horses as an alternative

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

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

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

Article

Benzodiazepines for Anxiety: Where They Fit In

From The Carlat Psychiatry Report, Anxiety

Topics: Anxiety | Anxiety Disorder | Free Articles | Registered Articles

Benzodiazepines (BZDs) are widely used, rarely studied, and much maligned. So where exactly do they fit in today’s medication arsenal for treating anxiety? In this article, I will discuss when BZDs are appropriate and when they are not, and how to choose among the various BZDs. But before doing so, let’s first address the elephant that always see

Expert Q&A

Acting Out: Is It Anxiety?

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

Topics: Anxiety Disorder | Child Psychiatry

CCPR: We see so many kids who are acting out. Can you begin by telling us about how anxiety can be hidden in oppositional or other acting-out behavior? Dr. Glovinsky: I see that all the time. What you’re bringing up are two groups. One group looks like oppositional behavior with comorbid anxiety underneath. The other is a group of kids who are hav

Research Update

Is D-Cycloserine Useful for Panic Disorder Treatment Augmentation?

From The Carlat Psychiatry Report, Working With Families

Topics: Anxiety Disorder | Research Update

Review of: Hofmeijer-Sevink MK et al, J Clin Psychopharmacol 2017;37(5):531–539 The mainstay of current treatment for panic disorder involves SSRIs and psychotherapy, specifically either cognitive behavioral therapy (CBT) or exposure with response prevention (ERP) therapy. D-cycloserine (DCS) is a partial N-methyl-D-aspartate (NMDA) receptor agonis

Research Update

Can Mindfulness-Based Stress Reduction Affect Symptom Outcomes in Older Adults?

From The Carlat Psychiatry Report, PTSD

Topics: Anxiety Disorder | Research Update

Review of: Wetherell JL et al, J Clin Psychiatry;78(7):e734–e743 Mindfulness-based stress reduction (MBSR) is a formalized combination of mindfulness meditation, body awareness, and yoga. The technique has been shown to help with symptoms of depression and anxiety, and some preliminary small studies have hinted that it might improve both memory and

Article

ConsumerLab.com: Guiding Patients Toward OTCs That Won’t Hurt Them

From The Carlat Psychiatry Report, Antidepressants

Topics: Anxiety Disorder | Natural Medications | Practice Tools and Tips

“It’s rare that my patients don’t at some point or another try an over-the-counter sleep aid, anxiety preparation, or antidepressant supplement,” says TCPR board member Richard Gardiner, MD, who practices psychiatry in Mendocino County, California. While supplements may be helpful—we covered this topic in TCPR’s November/December 2016 issue�

From The Carlat Psychiatry Report,

From The Carlat Psychiatry Report,

From The Carlat Psychiatry Report,

If you are interested in part-time correctional work, the best place to start is often the local jail—as opposed to a prison. What’s the difference between the two? A jail is a criminal justice facility operated by a city or county. It houses people who are awaiting trial or who have received short sentences, typically one year or less. In c

Article

Psychopharmacology in Jails: An Introduction

From The Carlat Psychiatry Report, Correctional Psychiatry

If you are interested in part-time correctional work, the best place to start is often the local jail—as opposed to a prison. What’s the difference between the two? A jail is a criminal justice facility operated by a city or county. It houses people who are awaiting trial or who have received short sentences, typically one year or less. In contrast,

Article

Medication Treatment of Anxiety Disorders in Substance Abusers

From The Carlat Addiction Treatment Report, Benzodiazepines

Topics: Addiction | Anxiety Disorder | Benzodiazepines | Psychopharmacology Tips

Among substance abusers, anxiety seems to be more the rule than the exception. Studies show that up to 50% of patients with alcohol dependence or drug dependence have some type of anxiety disorder (Lai HM et al, Drug Alcohol Depend 2015;154:1–13). But anxiety comes in many flavors other than official DSM disorders. In any given substance-abusing

Expert Q&A

Benzodiazepines: Dependence, Tolerance, and Addiction

From The Carlat Addiction Treatment Report, Benzodiazepines

Topics: Addiction | Anxiety Disorder | Benzodiazepines | Psychopharmacology Tips

Expert Q&A

The Experience of Correctional Psychiatry

From The Carlat Psychiatry Report, Correctional Psychiatry

TCPR: Dr. Gariety, please tell us a bit about your background. Dr. Gariety: I’ve been in practice for 23 years, starting out in community mental health, followed by 13 years in the federal bureau of prisons. Currently I work for a large regional medical group in the private sector. TCPR: Tell me a bit more about the correctional setting. D