An Antidepressant Diet

Topics: Antidepressants | Depression | Nutrition | Registered Articles

TCPR: A few years ago, your group conducted the first clinical trial of diet on depression. Where did you get the idea for that? Dr. Jacka: We had a decade of observational evidence linking the quality of people’s diets to their risk for depression. Those findings were pretty consistent across countries, cultures, and age groups: A healthy diet is

Practicalities of Providing Volunteer Services for Youth Refugees or Asylum Seekers

Topics: Family Separation | Free Articles | Registered Articles | Trauma

We hear of many children and adolescents who are refugees, most seeking asylum. There are calls for professionals to meet the needs of these people. How hard is it to do this—to take time off from regular practice to work in a different setting? It’s easier than you might think. However, is this kind of work as rewarding as people say? Can it be a r

Coffee: Healthy Study Aid or the Addiction We Hate to Acknowledge?

Topics: Addiction | Caffeine | Free Articles | Registered Articles | Substance Abuse

Caffeine permeates our society. It comes in many forms, including coffee and increasingly popular energy drinks. We consume it, and so do our patients. So, is it a harmless habit or a potentially harmful addiction? Let’s take a sip and find out. Is it addictive? The WHO in ICD-10 recognizes the diagnosis of substance dependence due to caffeine, an

More Evidence of Lives Saved by Medications for Opioid Use Disorder

Topics: Opioids | Registered Articles | Research Update

REVIEW OF: Larochelle MR et al, Ann Intern Med 2018;169(3):137–145 We are in the middle of an opioid crisis in the US, with many lives lost daily to opioid-related deaths. Pharmacotherapy with methadone, buprenorphine, or naltrexone represents an important tool for clinicians during this crisis. But just how good are these medications in saving liv

Harnessing Beneficial Drug Interactions

Topics: Practice Tools and Tips | Psychopharmacology Tips | Registered Articles

It’s nice when we can get our patients better with a single medication, but that’s not always possible. Sometimes the right combination of meds can do the trick, but studies of polypharmacy are scarce. In this article we dig through that research, small and limited as it is, to highlight a few useful combinations where the drug interaction can benef

Becoming Successful Despite ADHD

Topics: ADHD | Psychotherapy | Registered Articles

CCPR: Dr. Katz, how did you get interested in this topic? Dr. Katz: There’s a body of research exploring the lives of those who overcame a range of adverse childhood experiences, including learning-related challenges. I’ve always been interested in this work. Parents at our center are often surprised to learn that successful adults in every prof

Treatment-Resistant Depression: Some Introductory Tips

Topics: Antidepressants | Bipolar Disorder | Depressive Disorder | Registered Articles

Treatment-resistant depression (TRD) has a fairly low barrier of entry. Failure of 2 full antidepressant trials—lasting 6 weeks at a minimally effective dose—is enough to qualify. In this month’s issue of TCPR, we’ll highlight pharmacologic advances that are underutilized and debunk a few that are unlikely to be effective for TRD. But first, we

Adolescents With ADHD and Substance Use Disorders: A Primer

Topics: Addiction | ADHD | Child Psychiatry | Registered Articles | Substance Abuse

You are evaluating a 16-year-old boy referred for mandated substance use treatment by his high school, where he was found drinking alcohol and smoking cannabis with a friend in the restroom. As you gather his history, he says, “One doctor told me I have ADHD. That’s why I smoke pot—it helps me focus. But I think I’d do better with some Adderall.

Treating Chronic Pain When There’s Addiction: A Primer

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

It can be challenging to manage chronic pain, even more so when our patients suffer from addiction. We can find ourselves walking a tightrope between the risk of relapse due to the inadequate treatment of pain, and the risk of relapse due to the use of opioid analgesics. Since our mission is to minimize suffering and optimize functioning while helpin

Benzodiazepines for Anxiety: Where They Fit In

Topics: Anxiety | Anxiety Disorder | Free Articles | Registered Articles

Benzodiazepines (BZDs) are widely used, rarely studied, and much maligned. So where exactly do they fit in today’s medication arsenal for treating anxiety? In this article, I will discuss when BZDs are appropriate and when they are not, and how to choose among the various BZDs. But before doing so, let’s first address the elephant that always see

Prescribing and Managing Antipsychotics

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

TCPR: Dr. Schwartz, there are so many antipsychotics available. How do you choose in your own practice? Dr. Schwartz: Any drugs that have an FDA indication for a particular diagnosis are likely to be effective. I especially like to use those that have less risk of metabolic complications, such as ziprasidone, lurasidone, etc. If we are discussing eff

Substance Use in Pregnancy: What to Tell Patients

Topics: Addiction | Registered Articles | Substance Abuse | Women's Issues in Psychiatry

As an OB/GYN physician with a special interest in opioid use disorders during pregnancy, I see many women of childbearing age who are struggling with a substance use disorder. Some of these women are contemplating pregnancy, while others are already pregnant. I often collaborate with psychiatrists when treating these women, and I enjoy sharing knowledge

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

Some Helpful CBT Techniques for Specific Disorders

Topics: Practice Tools and Tips | Psychotherapy | Registered Articles

When we first set about planning this article, its working title was “The Most Evidence-Based Psychotherapies.” But as we scoured the literature, it became clear that there’s no scientific consensus about which techniques are best (one exception to this being techniques for OCD—see page 3). In fact, the latest official statement on the subject b

Screen Media and Mental Health Risks

Topics: Registered Articles

This issue of the Carlat Child Psychiatry Report takes on a topic that is on the minds of child mental health clinicians and (of course) pediatricians, parents, and teachers: Is 24/7 immersion in screen media negatively affecting our children? I have been helping patients of all ages, as well as the general public, address this in practical and socially