Deprescribing Carlat Reports | Carlat Publishing

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

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

Gabapentin Misuse and Diversion

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

CATR: Could you start by telling us a little bit about yourself and your current work? Dr. Vickers-Smith: I am an epidemiologist, and my work has primarily been on gabapentin as an emerging drug of recreational and unhealthy use. This interest came about while I was working for Dr. Jennifer Havens on her cohort of about 500 individuals in central Appal

Clinical Update

Muscle Relaxants: Sedatives Often Under the Radar

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

Muscle relaxants are a diverse group of medications with varying mechanisms of action (see Commonly Prescribed Muscle Relaxants table below). They are indicated for short-term treatment (2–3 weeks) of acute, painful muscle spasms, as well as some chronic neurologic conditions associated with spasticity. However, many patients with chronic pain are on

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

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

Expert Q&A

Psychotherapy and Medication in Recurrent Depression

From The Carlat Psychiatry Report, Depression

TCPR: When depression is recurrent, we usually continue the antidepressant indefinitely. Has that practice come under challenge? Dr. Fava: Yes. Antidepressant drugs are certainly important during the depressive episode, but what we are starting to question is whether they are as effective in preventing relapse. A meta-analysis from 12 years ago found t

Expert Q&A

How to Come Off a Psych Med Part 2: Antidepressants, Stimulants, and Benzos

From The Carlat Psychiatry Report, Stopping Psych Meds Part 2

Topics: Antidepressants | Benzodiazepines | Deprescribing | Withdrawal

TCPR: Before we talk about your experience with tapering medications, tell us about the population you work with.Dr. Gupta: In the past, I worked at the Connecticut Mental Health Center for Yale University. There I saw patients with pretty serious mental illness: mainly psychotic disorders, severe trauma, addictions, and serious psychosocial stressors

Research Update

Are SSRIs Associated With Increased Rates of Violence?

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

REVIEW OF: Lagerberg et al, Eur Neuropsychopharm 2020;26:1–9 TYPE OF STUDY: Analysis of Swedish national registries Soon after the introduction of SSRIs in 1988, case reports began to emerge suggesting that they might trigger violence in a small subset of patients. At the time, such reports were mostly dismissed and attributed to the fact that p

Research Update

How to Switch Antipsychotics

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

Review of: Takeuchi H and Remington G, J Psychopharmacol 2020;34(8):914–919 Type of study: Meta-analysis of randomized controlled trials Antipsychotic switching is a routine part of schizophrenia care, but what’s the best way to go from one medication to another? This article compared three strategies: 1) abruptly stopping the old antipsychotic 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

Research Update

An Answer for Psychotic Depression

From The Carlat Psychiatry Report, Inflammation and Depression

REVIEW OF: Flint AJ et al, JAMA 2019;322(7):622–631 TYPE OF STUDY: Randomized, placebo-controlled trial Psychotic features in depression indicate a more severe form of the disease, with a higher risk of hospitalization and double the rate of disability compared with non-psychotic depression. A combination of an antipsychotic and an antidepressant is

Expert Q&A

Deprescribing Medication

From The Carlat Psychiatry Report, Deprescribing

Topics: Deprescribing | Psychopharmacology

There’s no shortage of information on prescribing medications, but when and how do we stop them? The Bruyere Deprescribing Guidelines Research Team is a group of clinicians and researchers who’ve set out to answer those questions. They’ve recently published 5 deprescribing guidelines, 3 of which are for psychiatric medications: benzodiazepines, an