Second-Generation Antipsychotics Do Not Raise Risk of Major Malformations

Topics: Antipsychotics | Psychopharmacology Tips | Research Update

Subject: (Cohen L et al, JAMA Psychiatry 2016;173:263–270) Short Description: Second-generation antipsychotics (SGA) are used for a variety of psychiatric conditions, but even though they’ve been around for 20 years, we know little about what impact they have on the developing fetus. These medications are widely considered to be relatively safe

Four Newer Antidepressants: Should You Use Them?

Topics: Antidepressants | Depressive Disorder | Practice Tools and Tips | Psychopharmacology Tips | Seasonal Affective Disorder

Since 2011, 3 new antidepressants have been approved by the FDA, and another (ketamine) has been generating buzz as a potential off-label medication for depression. In this article, we’ll take a step back and review the data on vilazodone (Viibryd), levomilnacipran (Fetzima), vortioxetine (Brintellix), and ketamine. Vilazodone (Viibryd) Vilazodone

Thinking Creatively About Treatment-Resistant Depression

Topics: Antidepressants | Depressive Disorder | Practice Tools and Tips | Psychopharmacology Tips | Seasonal Affective Disorder

TCPR: The term “treatment-resistant depression” is sort of thrown around a bit. I’m sure that there are various formal or informal definitions of it, but how do you think about it? Dr. Bodkin: The formal definition basically requires 2 failures of distinctly different antidepressants at robust doses for adequate duration. But personally, I thin

How to Treat Opiate Use Disorders

Topics: Addiction | Free Articles | Practice Tools and Tips | Psychopharmacology Tips

Opiate use disorder is increasingly common, and it is important to develop a systematic approach for treating it. In this article, I will discuss some of the more important elements of treatment, starting with the need to address patients’ denial and moving on to some of the nitty gritty aspects of medication-assisted treatment. Acknowledging the p

Naloxone and the Harm Reduction Approach

Topics: Addiction | Practice Tools and Tips | Psychopharmacology Tips

Before You Write That Prescription: Guidelines for Ordering Lab Tests

Topics: Laboratory Testing in Psychiatry | News of Note | Practice Tools and Tips | Psychopharmacology Tips

Mental health clinicians often ask for a single, black-and-white answer to the question: Which lab tests should I order before starting this particular medication? Inevitably, the answer is that it depends. However, there are some guidelines that are useful. When it comes to ordering lab tests, it sometimes feels like we are “damned if we do, and d

Distinguishing Between Medical and Psychiatric Conditions

Topics: Laboratory Testing in Psychiatry | Medical Comorbidities | Practice Tools and Tips | Psychopharmacology Tips

Cariprazine (Vraylar): A drug for negative symptoms? Don’t be positive.

Topics: Antipsychotics | News of Note | Psychopharmacology Tips

Antidepressant Use in Children and Teenagers

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

Foster Care and Child Psychiatry: A Primer

Topics: Antipsychotics | Child Psychiatry | Free Articles | Practice Tools and Tips | Psychopharmacology Tips | Psychotherapy | PTSD

In this issue of CCPR we focus on the treatment of children in foster care systems. Nearly one in three of these children have significant psychiatric problems during their time in foster care—especially those related to trauma and neglect that brought them into the system (McMillen JC et al, J Am Acad Child Adolesc Psychiatry 2005;44(1):88–95). Rec

A Narcolepsy Primer, With a Focus on Xyrem

Topics: Psychopharmacology Tips | Sleep Disorders

Narcolepsy affects about 1 out of 2000 people, for a prevalence rate of 0.05%. This puts it officially in the category of rare diseases. It’s about as common as Charcot-Marie-Tooth disease, or polycythemia vera, just to put it in perspective. So why are we asking you to read about such a rare disorder? Partly because there’s a lot of comorbidity bet

Managing Psychotropic Treatment with Foster Children

Topics: Antipsychotics | Child Psychiatry | Psychopharmacology Tips | PTSD

Janey is 5. She hits and she bites. Her third foster mother, Sandy, is thinking it’s too much to handle. I am her new psychopharmacologist. Janey arrives with a thick chart documenting in utero substance exposure, early neglect, many placements, and symptoms consistent with many DSM-5 diagnoses, including reactive attachment disorder, generalized anxi

What Psychiatrists Should Know About Sleep Medicine

Topics: Benzodiazepines | Practice Tools and Tips | Psychopharmacology Tips | Sleep Disorders

Beyond Medications: Psychosocial Methods for Helping Challenging Kids

Topics: Child Psychiatry | Psychopharmacology Tips | Psychotherapy

Foster children tend to be over-medicated. Surveys show that foster youth receive 5 times the number of psychotropic medications, frequently three or four simultaneously, as privately insured children. What else, beside medications, can we offer foster children who are often struggling with psychiatric issues and difficult and unfamiliar family envir

Should We Add Stimulants to SSRIs to Treat Geriatric Depression?

Topics: Depressive Disorder | Psychopharmacology Tips | Research Updates

The Politics of Medicating Children: Problems and Solutions

Topics: Child Psychiatry | Psychopharmacology Tips | PTSD

Medication Strategies for Helping People with Autism Spectrum Disorders

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

Getting meds just right is challenging in autism. Sometimes we succeed. For example, a woman with minimal verbal ability is extremely aggressive. She is on a number of medications including valproate 1000 mg extended release, paroxetine 40 mg, ziprasidone 40 mg twice a day, alprazolam 1 mg twice a day, and a host of supplements. She settles down conside

Evaluating and Treating Autism: Practical Issues

Topics: Anxiety Disorder | Child Psychiatry | Practice Tools and Tips | Psychopharmacology Tips

Binge Eating Disorder: Should You Use Vyvanse?

Topics: Eating Disorders | Practice Tools and Tips | Psychopharmacology Tips | Psychotherapy

In January of this year, the FDA approved the stimulant lisdexamfetamine (Vyvanse) as the first drug with an indication for binge eating disorder (BED). Patients are hearing the buzz and may be asking you to prescribe it, but you may have some questions first. Is BED different from extreme overeating which plagues so many Americans? Is this just a stimu

The New Three-Month Version of Injectable Paliperidone: Should You Use It?

Topics: Antipsychotics | Psychopharmacology Tips | Research Updates