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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 (

Research Update

SSRIs and Intracerebral Hemorrhage Risk

From The Carlat Hospital Psychiatry Report, Capacity Assessments

REVIEW OF: Kubiszewski P et al, JAMA Neurol 2020;e203142. Epub ahead of print. Depression after strokes is very common, affecting about 50% of stroke patients. Many such patients are treated with SSRIs, which are generally effective but potentially dangerous because they can increase the risk of bleeding due to impaired platelet aggregation. This is

Research Update

Can Antidepressants Prolong Survival in Cancer Patients?

From The Carlat Hospital Psychiatry Report, Capacity Assessments

Review Of: Shoval G et al, Depress Anxiety 2019;36(10):921–929 Many cancer patients experience depression, especially those with poor prognoses. Compared with euthymic patients, depressed cancer patients are less adherent to their cytotoxic medications, and this poor adherence can worsen their long-term survival. Yet surprisingly, some studies have

Expert Q&A

How to Come Off a Psych Med Part 1: Antipsychotics

From The Carlat Psychiatry Report, Stopping Psych Meds Part 1

TCPR: There are a lot of books on deprescribing from the antipsychiatry movement, but your book seems to take a different approach.Dr. Gupta: The biggest difference is that the authors of this book all acknowledge that there is a place for psychotropic medications. They can be extremely beneficial for the patient in the right situation. My concern is wi

How to Select an SSRI

From The Carlat Psychiatry Report, Practical Psychotherapy

On March 14, 2012, Lexapro became the last SSRI to lose its patent, closing the book on a quarter century of science and marketing that changed and sometimes confused the way we think about antidepressants. Now that the unpublished studies have come to light and the incentives to favor one drug over another have dried up, it’s a good time to take a so

Expert Q&A

Mood and Menopause

From The Carlat Psychiatry Report, Mood and Menopause

TCPR: When does perimenopausal depression tend to start?Dr. Nonacs: It’s during the transition into menopause that women are most vulnerable to depression. And that transition can actually take quite a while, like 5–7 years. TCPR: How does it present?Dr. Nonacs: Often they’ve had a history of depression, but have done fairly well up to this point

Expert Q&A

The Psychopharmacology Algorithm Project

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

TCPR: What would be the biggest change in practice if psychiatrists followed your algorithms?Dr. Osser: One area is bipolar depression. This is a disorder where there is an exceptionally large deviation between what the evidence says and what people are doing, especially when it comes to antidepressants. They are still being used rampantly, even in pati

Research Update

Optimal Antidepressant Doses in Major Depression

From The Carlat Psychiatry Report, Bipolar II

Review of: Furukawa TA et al, Lancet Psychiatry;2019;6(7):601–609 Type of study: Systematic review and meta-analysis Most antidepressants do not have a linear response curve. In other words, the benefits level off as the dose goes up. If the dose gets too high, the side effects start to outweigh those diminishing returns. What’s not clear is whe