Bipolar Depression Carlat Reports

Clinical Update

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

Research Update

Lumateperone in Bipolar Depression

From The Carlat Psychiatry Report, Schizophrenia

Topics: Bipolar Depression | Bipolar Disorder | Bipolar II | Lumateperone | Second Generation Antipsychotics (SGAs)

REVIEW OF: Calabrese JR et al, Am J Psychiatry 2021. Epub ahead of print STUDY TYPE: Randomized, placebo-controlled trial In 2019, lumateperone (Caplyta) became the 13th atypical antipsychotic with FDA approval in schizophrenia. Compared to other atypicals, it is relatively well tolerated, with low rates of akathisia and metabolic side effects. On

Research Update

A Novel Treatment for Methamphetamine Use Disorder

From The Carlat Psychiatry Report, Schizophrenia

Topics: Bipolar Depression | Bipolar Disorder | Bipolar II | Lumateperone | Second Generation Antipsychotics (SGAs)

REVIEW OF: Trivedi MH et al, N Engl J Med 2021;384(2):140–153 STUDY TYPE: Randomized, double-blind, placebo-controlled trial with sequential parallel comparison design Methamphetamine use disorder is an increasing cause of overdose deaths in the US. Pharmacologic options are scarce, but pilot studies suggest that bupropion and naltrexone may be

Expert Q&A

How to Diagnose Bipolar Disorder

From The Carlat Psychiatry Report, Bipolar Disorder

TCPR: When I ask a depressed patient if they’ve ever had manic symptoms, I often run into a problem. They say, “Of course I feel more confident, energetic, and happy ... when I’m not depressed.”Dr. Parker: As it can be hard to tease apart true hypomania from normal happiness, we’ve developed a rating scale to assist, the Sydney Bipolar Screene

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

Maintenance Pharmacotherapy of Bipolar Disorder: How Long Is Long Enough?

From The Carlat Psychiatry Report, Problems with Generics

Review of: Kishi T et al, Psychol Med 2020 Oct 13:1–9; PMID: 33046156 Type of study: Meta-analysis of double-blind, randomized placebo-controlled trials Bipolar disorder is a lifelong illness whose treatment is an ongoing challenge, complicated not least by difficulties in treatment adherence. What do we know and what can we tell our patients about

Research Update

Antidepressants Harm Some With Bipolar Depression

From The Carlat Psychiatry Report, Metabolism and Mental Health

Topics: Antidepressants | Bipolar Depression | Bipolar Disorder

REVIEW OF: Ghaemi SN et al, J Clin Psychiatry 2021;82(1):19m13136 Study TYPE: Randomized, double-blind, placebo-controlled trial Antidepressants are controversial in bipolar depression, in part because we don’t have enough well-designed studies to clarify their role. The most rigorous trials have come up negative, and many of the positive ones s

Clinical Update

How to Use Lamotrigine

From The Carlat Psychiatry Report, Mind-Gut Connection

Lamotrigine is FDA approved as maintenance treatment for bipolar disorder—that is, for delaying episodes of depression, hypomania, or mania. However, it is not approved for active depression or mania—which has given it a reputation as a “light” mood stabilizer. For patients who appreciate tolerability, that’s a good thing, but it isn’t the f

Research Update

Mood Stabilizers: What You Don’t Know Can Hurt Them

From The Carlat Psychiatry Report, Mood and Menopause

Review of: Bai Y et al, J Clin Psychopharmacol 2020;40(2):167–179 STUDY TYPE: Combined meta-analysis and literature review of placebo-controlled trials Medication adherence is an ongoing struggle in bipolar disorder, and it’s compounded by the fact that our patients often don’t advertise their non-adherence. While numbers vary, reviews general

Research Update

A New Antipsychotic for Bipolar Depression

From The Carlat Psychiatry Report, Traumatic Brain Injury

Lumateperone (Caplyta) just hit the pharmacy shelves with FDA approval in schizophrenia (see TCPR March 2020), and its manufacturer is pursuing further approval for bipolar depression. So far they’ve completed two phase III trials—one negative and one positive—and the positive one was presented in poster form by Suresh Durgam and colleagues at the

News of Note

A New Treatment for Bipolar Depression

From The Carlat Psychiatry Report, Side Effects Part II

On May 28, 2019, cariprazine (Vraylar) became the fourth atypical antipsychotic to receive FDA approval for bipolar depression. The approval was based on two randomized controlled trials involving 1,051 patients and lasting 6–8 weeks. These studies grouped patients into fixed doses from 0.75–3 mg/day. The sweet spot seems to be 1.5 mg/day, which was