How Ethnicity Influences Medication Response

Topics: Practice Tools and Tips | Psychopharmacology Tips

From cultural expectations to genetic variations, ethnicity has a strong effect on medication response. In this article, we’ll review five areas where ethnic groups can differ in their biological response to psychiatric medications. Drug metabolism Most medications are metabolized in the liver, and patients’ liver metabolism varies. Slow metabol

Non-Addictive, Pharmacological Options for Sleep

Topics: Addiction | Free Articles | Psychopharmacology Tips | Sleep Disorders | Substance Abuse

In this month’s interview with Dr. Eric Hermes, we learned about his approach to treating insomnia in patients with substance use disorders, with a focus on cognitive behavioral therapy. In this article, we’ll look at some non-addictive pharmacological options. That means we’re not going to review any of the benzodiazepines or the non-benzodiazepi

Is Varenicline Effective for Alcohol Use Disorder?

Topics: Addiction | Psychopharmacology Tips | Research Update | Substance Abuse

REVIEW OF: O’Malley S et al, JAMA Psychiatry 2018;75(2):129–138 Acting on the nicotinic acetylcholine receptors, varenicline (Chantix) is an FDA-approved treatment for smoking cessation. These receptors are implicated in both nicotine and alcohol reward pathways, so could varenicline also be helpful for treating alcohol use disorder (AUD)? So far

Youth, Antidepressant Medications, and Type 2 Diabetes

Topics: Antidepressants | Child Psychiatry | Psychopharmacology Tips

Review of: Burco M et al, JAMA Pediatrics 2017;171(12):1200–1207 Over the last decade, several published studies have reported an increased risk of type 2 diabetes associated with antidepressant use in adults. But does the same hold true for children and adolescents? This paper is the first population-based study to examine the risk of onset of

Guidelines for Switching From Methadone to Buprenorphine

Topics: Addiction | Psychopharmacology Tips | Research Update

REVIEW OF: Lintzeris N et al, J Addict Med 2018. doi:10.1097/ADM.0000000000000396 Recent guidelines published by the American Society of Addiction Medicine and nationally in Australia provide support for transferring patients from methadone to buprenorphine-naloxone (BNX). Patients may switch, thinking BNX is easier to discontinue or because of metha

Lithium: Practical Considerations for Children With Suicidal Thinking

Topics: Child Psychiatry | Depressive Disorder | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Billy, age 10, has periods of intense aggression alternating with moments of wanting to be dead, severe mood swings, poor sleep, and pervasive irritability. He has a family history of bipolar disorder. Other family members have responded well to lithium. Since they want to act assertively to help him, Billy’s family is open to medication trials and an

Evidence Behind Aripiprazole for the Treatment of Tourette’s Disorder

Topics: Child Psychiatry | Psychopharmacology Tips | Research Update

Review of: Sallee F et al,   J Child Adolesc Psychopharmacol 2017;27(9):771–781 Tourette’s disorder (TD) is a movement disorder emerging during childhood that causes persistent motor and vocal tics. TD is treated with a variety of medications, but often with an off-label designation. There are only three medications that are FDA approved for

Psychopharmacology for Patients With Intellectual Disability

Topics: Practice Tools and Tips | Psychopharmacology Tips

Anne, a 23-year-old woman with moderate intellectual disability, comes into your office accompanied by a staff member of her group home. The staffer reports that Anne has been aggressive toward her roommate and has appeared more aloof over the last week. He is ­curious whether you can prescribe a medication to prevent future episodes of aggression.

Interviewing and Evaluating Patients With Intellectual Disability

Topics: Practice Tools and Tips | Psychopharmacology Tips

TCPR: Let’s start with the basics. What exactly is the definition of intellectual disability (ID)? Dr. Gentile: DSM-5 identifies it as an IQ of 70 or lower. Then there are ranges: mild, moderate, and severe/profound. Someone in the mild range has an IQ, generally, of 70 at the upper end and 50 to 55 at the lower end. The moderate range is 50 or 55

Helping People With Co-Occurring Mental Health and Substance Use Disorders

Topics: Practice Tools and Tips | Psychopharmacology Tips | Substance Abuse

Patients with co-occurring disorders (COD, also known as “dual diagnosis”) are often regarded as among the most challenging patients to treat. You need to track two conditions that interact in unpredictable ways, with patients who may not be inclined to follow your recommendations. It’s no surprise that such patients typically have poorer outcomes

Take The CME Post-Test for Dual Diagnosis, CATR, August 2017

Topics: Practice Tools and Tips | Psychopharmacology Tips | Research Updates | Substance Abuse

The post-test for this issue is available for one year after the publication date to subscribers only (December 31, 2017). By successfully completing the test you will be awarded a certificate for 1 CME credit. Click here to take your CME test. Note: All of the CME tests are available in the “My Account” section of the site when you are logged

Beginning Antidepressant Treatment: A Recommended Approach

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

How do you start a new patient on antidepressant treatment? We do this countless times in our practices, and reviewing the topic may feel a bit like returning to residency. However, it’s important to revisit our standard operating procedures from time to time to ensure we’re thinking carefully about our decisions during our busy days. If we turn

When First-Line Depression Treatments Don’t Cut It: Newer Antidepressants and Sometimes, Antipsychotics

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips | Registered Articles

TCPR: It’s been about 10 years since we last talked with you about the practical use of antidepressants with so many drugs to choose from. Over the last few years, three new antidepressants have come out: vilazodone (Viibryd), vortioxetine (Trintellix), and levomilnacipran (Fetzima). My sense is that an awful lot of clinicians still haven’t changed

When Depression Meds Fail, Transcranial Magnetic Stimulation Might Be Plan B

Topics: Antidepressants | Depressive Disorder | Psychopharmacology Tips

TCPR: How treatment-resistant does a patient have to be with antidepressants before you should consider trying TMS? Dr. Becker: When TMS initially came out in 2008, it was approved for people who had failed one medication trial. But I’ll tell you, from doing a number of insurance reviews, that health insurers are going to require on average about f

High-Dose Citalopram and Escitalopram: Undeserved Bad Rap?

Topics: Depressive Disorder | Psychopharmacology Tips | Research Updates

Review of: Ray WA et al, High-dose citalopram and escitalopram and the risk of out-of-hospital death. J Clin Psychiatry 2016. doi:10.4088/JCP.15m10324 Study type: Retrospective cohort study Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line treatment for depression; however, our confidence in their safety took a hit when

SSRIs May Work More Quickly in Pediatric OCD Than You Realize

Topics: OCD | Psychopharmacology Tips | Research Updates

Review of: Varigonda A et al. Journal of the American Academy of Child & Adolescent Psychiatry 2016; ahead of publication. STUDY TYPE: Systematic literature review and meta-analysis The pharmacological treatment of obsessive-compulsive disorder (OCD) for adults is pretty well worked out. Selective serotonin reuptake inhibitors (SSRIs) are the

Managing Pain: A Cognitive Behavioral Therapist’s Approach [Free Article]

Topics: Addiction | Pharmaceutical Industry | Practice Tools and Tips | Psychopharmacology Tips | Psychotherapy | Substance Abuse

Efficacy of Quetiapine in PTSD

Topics: Psychopharmacology Tips | PTSD | Research Updates

Sexual Side Effects of the Newer Antidepressants

Topics: Practice Tools and Tips | Psychopharmacology Tips | Sexual Dysfunction

It’s no secret that SSRIs and SNRIs cause sexual dysfunction (SD) in a large proportion of patients who take them. The exact size of that proportion, though, is difficult to pinpoint with any reliability. Most of the large clinical trials of antidepressants ascertain side effects through spontaneous reports, and research subjects are understandably em

Efficacy of Quetiapine in PTSD

Topics: Psychopharmacology Tips | PTSD | Research Update

Review of: Villarreal G, Hamner MB, Cañive JM, et al. Efficacy of quetiapine monotherapy in posttraumatic stress disorder: a randomized, placebo-controlled trial. JAMA Psychiatry 2016:ahead of publication. Study Type: Placebo-controlled, double-blinded clinical trial Post-traumatic stress disorder (PTSD) is arguably one of the most difficult psy