Pharmacology Tips Carlat Reports

Clinical Update

From The Carlat Psychiatry Report, Telepsychiatry

If your practice is anything like mine, trazodone is your go-to hypnotic. As an antidepressant, it’s an afterthought, dismissed as ineffective or intolerable since its release in 1981. Four decades and over 200 clinical trials later, it’s a good time to see if we’ve missed any opportunities in this forgotten antidepressant. How trazodone worksTra

Expert Q&A

The Schizophrenia-OCD Overlap

From The Carlat Psychiatry Report, Mood Disorders

TCPR: What is schizo-obsessive disorder?Dr. Poyurovsky: Schizo-obsessive disorder (schizo-OCD) is not a DSM diagnosis. The term is used to refer to patients with schizophrenic disorders that have comorbid features of OCD. We see these obsessive-compulsive symptoms in schizophrenia more often than would be expected by chance. About one in four patients h

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

Clinical Update

Keeping Up With Trintellix

From The Carlat Psychiatry Report, Mood and Menopause

In a previous report (TCPR, Feb 2019), we summarized the data on cognitive effects associated with vortioxetine (Trintellix). We found that vortioxetine produced impressive results for cognition based on improvement on the Digital Symbol Substitution Test (DSST), and gave Takeda Pharmaceuticals high marks for choosing to compare vortioxetine to duloxeti

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

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

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

Article

Mirtazapine Augmentation: Running Low on Rocket Fuel

From The Carlat Psychiatry Report, How to Talk about Medication

Adding mirtazapine (Remeron) to a serotonergic antidepressant is a popular augmentation strategy. When added to venlafaxine, the combo was thought to possess a particularly potent synergy that Stephen Stahl called “California Rocket Fuel.” However, the strategy has failed in a handful of new studies, some of them much larger than the original data.

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

l-Methylfolate for Depression: Costly Mistake or Good Thinking?

From The Carlat Psychiatry Report, Side Effects Part II

Folate (Vitamin B9) has a long track record as a low-cost, low-risk augmentation strategy in depression. It’s also available in a more expensive form, l-methylfolate (Deplin), that promises better results but at a premium price. So, is the cost worth it? Folate pathwaysFolate (the natural form of folic acid) is a B vitamin that’s important in psych

Expert Q&A

Medication Side Effects Part II: Weight Gain, Akathisia, Hair Loss, and Orthostasis

From The Carlat Psychiatry Report, Side Effects Part II

Editor’s note: In the June/July issue, Dr. Mago shared a sampling of his strategies for nausea, sweating, and dry mouth. We wrap up that conversation here with a few more tips on managing side effects. Weight gain TCPR: What’s your approach to antipsychotic-induced weight gain? Dr. Mago: Prevention is better than treatment. So, when possible, we

Expert Q&A

Medication Side Effects: Nausea, Sweating, and Dry Mouth

From The Carlat Psychiatry Report, Side Effects Part I

Topics: Pharmacology | Pharmacology Tips | Side Effects

TCPR: What’s the best way to manage side effects: lower the dose of the current medication or use an antidote? Dr. Mago: If the patient can stay well on a lower dose, that’s usually my first approach. Most side effects are dose related. TCPR: For the rest of this interview, we’ll assume that lowering the dose or changing the medication was not

Research Update

A New Proposal for SSRI Withdrawal

From The Carlat Psychiatry Report, Side Effects Part I

Topics: Pharmacology | Pharmacology Tips | SSRIs | Withdrawal

Review of: Horowitz MA and Taylor D, Lancet Psychiatry, March 2019, published online Type of Study: Literature review and clinical guideline Withdrawal problems rank among patients’ top concerns with antidepressants. They include insomnia, flu-like symptoms, irritability, distractibility, and unusual sensory experiences such as “brain zaps.” To

Article Link

SSRI withdrawal symptoms

From The Carlat Psychiatry Report, Side Effects Part I

Topics: Pharmacology | Pharmacology Tips | SSRIs | Withdrawal

Withdrawal problems rank among patients’ top concerns with antidepressants. They include insomnia, flu-like symptoms, irritability, distractibility, and unusual sensory experiences such as “brain zaps.” Use this PDF tool to check if the patient is having any SSRI withdrawal symptoms at baseline.

Expert Q&A

Considerations When Prescribing Psychotropic Medications

From The Carlat Child Psychiatry Report, Psychotropic Risks in Children and Adolescents

Topics: Child Psychiatry | Pharmacology Tips

CCPR: Thank you for joining us. To start things off, how do you approach using psychotropic medications for children and adolescents? Dr. Chenven: Most parents do not want to start medications. I empathize with them, which then makes it possible to move together toward medications when indicated. I quote Dr. Oliver Wendell Holmes, Sr., who said, “If

Article

Metformin to Control Antipsychotic-Induced Weight Gain in Children

From The Carlat Child Psychiatry Report, Psychotropic Risks in Children and Adolescents

Topics: Antipsychotics | Child Psychiatry | Pharmacology Tips

Metformin has been used off-label for weight loss in psychiatry for many years, much of it for help with adult weight gain as a side effect of atypical antipsychotics. However, most trials of metformin for weight loss were actually conducted on the child and adolescent population. This article will look at the quality of the data in our pediatric pop

Article

Tips for Good Medication Practice

From The Carlat Child Psychiatry Report, Psychotropic Risks in Children and Adolescents

Topics: Child Psychiatry | Pharmacology Tips

Good practice using psychotropic medications with children and adolescents requires a psychiatrist to pay attention to a number of elements. The following are some recommendations from child psychiatrist Mark Chenven, MD, of the things you should observe and the rules you might want to follow while prescribing medications: Start low, go slow: Most

Article

Clozapine: A Fresh Look

From The Carlat Psychiatry Report, Antipsychotics Update

Topics: Antipsychotics | Free Articles | Pharmacology Tips | Practice Tools and Tips

Several trials show it to be a superior treatment option, yet clozapine remains the “red-headed stepchild” of antipsychotics. Even though large studies reveal clozapine has impressive efficacy, particularly with treatment-resistant schizophrenia, many of us are reluctant to use it. According to one study, of the 30% of patients who have treatment

Article

Abilify MyCite: Patient Care Breakthrough or Patent Extender?

From The Carlat Psychiatry Report, Antipsychotics Update

Topics: Antipsychotics | Free Articles | Pharmacology Tips | Practice Tools and Tips

You’ve probably heard about a new “digital pill” called Abilify MyCite. The product, which was FDA approved in November 2017, is the first drug in the U.S. with a digital ingestion tracking system. MyCite consists of an aripiprazole pill that contains an embedded tiny sensing device (about the size of a grain of sand) called the ingestible even