Lithium Carlat Reports | Carlat Publishing

Clinical Update

From The Carlat Psychiatry Report, College Mental Health

Topics: Alzheimers | Cognitive Decline | Dementia | Lithium

Your 65-year-old patient Mr. Hoffman recently saw his father through a devastating course of Alzheimer’s disease. Mr. Hoffman had his own risk assessed with ApoE genotyping, and the result—E4/E4—indicates a high risk. He comes to your office after reading an online article about low-dose lithium for dementia prevention and asks if you can prescrib

Clinical Update

Treatment of Antipsychotic-Induced Weight Gain

From The Carlat Psychiatry Report, College Mental Health

Topics: Antipsychotics | Bupropion | Dosing | Lithium | Schizophrenia

Antipsychotic-induced weight gain can decrease medication adherence, with a domino effect of negative consequences on the psychiatric illness. Recently the FDA approved the first therapy to address this problem: Lybalvi, a combination of olanzapine and samidorphan. In this article, I’ll look at how it compares with other treatments for antipsychotic-i

Clinical Update

Six Tips From Prescribing Psychotropics

From The Carlat Psychiatry Report, ADHD

Every day we are faced with prescribing dilemmas that don’t have ready answers. Instant or extended release? Brand or generic? With food or without? How should we adjust dosing to account for drug interactions, age, gender, ethnicity, or genetic testing results? Our new textbook Prescribing Psychotropics: From Drug Interactions to Pharmacogenetics is

Research Update

Lithium Exposure In Utero—How Bad Is It Really?

From The Carlat Hospital Psychiatry Report, Minimizing Use of Restraints

REVIEW OF: Fornaro M et al, Am J Psychiatry 2020;177(1):76–92 STUDY TYPE: Literature review Most of us are wary of prescribing lithium to pregnant patients, but is prenatal lithium exposure as risky as we think? A meta-analysis of 13 case-control, cohort, and interventional studies (n = 1,349,563 pregnancies) compared congenital anomalies among

Research Update

Which Medications Have the Lowest Risk of Side Effects?

From The Carlat Child Psychiatry Report, Mood Disorders in Children and Adolescents

REVIEW OF: Solmi M et al, World Psychiatry 2020;19(2):214–232 Adverse effects are important considerations when choosing psychotropic medications, especially in children and adolescents. This study pooled available research to compare the safety profiles of various psychotropics used in the pediatric population. The authors screened thousands of st

Research Update

Sleepwalking on Antipsychotics and Lithium

From The Carlat Psychiatry Report, Bipolar Disorder

REVIEW OF: Gouverneur A et al, Br J Clin Pharmacol 2021;87:3971–3977 STUDY TYPE: Retrospective analysis Sleepwalking and sleep-eating are common parasomnias, also known as somnambulism and sleep-related eating disorder. Both can be side effects of benzos, z-hypnotics, and—rarely—antidepressants. This review looked at parasomnias’ association w

Clinical Update

ECT Worked: Now What?

From The Carlat Psychiatry Report, Therapy

Juan is a 72-year-old man with severe depression who has not responded to numerous antidepressant trials. He is reluctant to undergo a course of electroconvulsive therapy (ECT), but agrees to do so if one last medication trial doesn’t work. After failing to respond to escitalopram augmented with aripiprazole, Juan receives a course of ECT and has a te

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

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

From The Carlat Psychiatry Report, Mood and Menopause

Topics: | | | | | | | | | | | | | | | | | | | | | | | | Antipsychotics Aripiprazole Asenapine Bipolar Depression Bipolar Disorder Bipolar II Cariprazine Lithium Lurasidone Mania Medication adherence Mood Stabilizers olanzapine Oxcarbazepine Pharmacology Pharmacology Tips Psychopharmacology Psychopharmacology Tips Quetiapine Research Research Update Risperidone safety Saphris Side Effects

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

Expert Q&A

Who Should Get Lithium?

From The Carlat Psychiatry Report, When to Use Lithium

TCPR: Lithium has been called the gold-standard treatment in bipolar disorder. Why is it not used more often? Dr. Rybakowski: That is a paradox. On the one hand, lithium is accepted as a first-line treatment for bipolar disorder, but it is also greatly underutilized. And I think there are two main reasons. One is aggressive promotion of branded mood st

Research Update

Two Augmentation Strategies Compared in Bipolar I

From The Carlat Psychiatry Report, When to Use Lithium

Review of: Missio G et al, Trials 2019;20(1):608 STUDY TYPE: Randomized, open-label controlled trial It’s rare to see full recovery in bipolar I disorder with a single medicine, so we often depend on some combination of mood stabilizers and/or antipsychotics. Even then, weight gain and metabolic problems are deal-breakers. Some experts favor the c

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

Mood Stabilizers and Stroke Risk in Bipolar Disorder

From The Carlat Psychiatry Report, Side Effects Part I

Topics: Bipolar Disorder | Lithium | Medical Comorbidities | Mood Stabilizers | Pharmacology

Review of: Chen PH et al, Br J Psychiatry 2018;1–6. doi:10.1192/bjp.2018.203 Study Type: Case-crossover study People living with bipolar disorder already have a decreased life expectancy of 10+ years compared to the general population (Crump C et al, JAMA Psychiatry 2013;70:931–939). Most of these years of lost life have been attributed to cardiov

Research Update

Lithium in Geriatric Depression

From The Carlat Psychiatry Report, Side Effects Part I

REVIEW OF: Buspavanich P et al, J Affect Disord 2019;251:136–140 TYPE OF STUDY: Prospective, non-randomized controlled trial Augmentation with lithium has long been established as an effective strategy for refractory depression, but how does it fare in geriatric patients? There is a dearth of evidence on lithium in the geriatric population, which

Article

Ask the Editor: Should You Prescribe Lithium to Suicidal Patients?

From The Carlat Psychiatry Report, Parenting, Pregnancy, and Prevention

Topics: Lithium | Pharmacology | Suicidality

Dear Dr. Aiken: You recommended lithium for suicidal patients in the TCPR 2018 summer issue, but isn’t there a risk of overdose with this strategy? Dr. Aiken: From firearms to bridges, the suicide rate goes down when we erect barriers to the means. Barriers work because suicidal impulses are brief, lasting only 1–2 hours on average. It