Research Carlat Reports | Carlat Publishing

Article

Are Target Symptoms More Important Than Diagnosis?

From The Carlat Child Psychiatry Report, ADHD in Children and Adolescents

Topics: ADHD | adolescents | Research | Teen | teens

Recently I evaluated Caroline, a 15-year-old patient who presented with symptoms of depression, including insomnia, poor appetite, loss of interest in friends and activities, and inability to focus on her schoolwork. In addition, Caroline described a sad, dark view of herself, the state of the world, and her future. It seemed clear that I needed to addr

Expert Q&A

Practical Approaches to Vetting Clinical Research

From The Carlat Child Psychiatry Report, Depression in Children and Adolescents

CCPR: Tell us a bit about your current work. What is your population? Whom do you treat? Dr. Courtney: My clinical population are patients with concurrent addictions and mental health issues. These patients present complex clinical challenges, and so I have made efforts to use a method to think about and sort through those problems. CCPR: Please sha

Research Update

Exposure Therapy Efficacious for PTSD Co-Occurring With Alcohol Use Disorder

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Review of: Norman SB et al, Efficacy 2019;76(8):791–799 Patients with co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) have worse outcomes compared to patients with either diagnosis alone. Integrated approaches, in which both diagnoses are simultaneously addressed, are viewed as best practice. Providers, however, are

Research Update

Varenicline and Bupropion: Soaring Again With EAGLES?

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Topics: | | | | | | | | | | | | | | | | | | | | Addiction Addiction Treatment Bupropion Chantix Co-occurring disorders Dual diagnosis FDA Warnings Medication Pharmacology Research Research Update Side Effects Smoking Cessation Smoking Cessation Agents Substance Use Substance use disorders Suicidality Suicide Tobacco Varenicline Wellbutrin

Review of: Anthenelli RM et al, Lancet 2016;387(10037):2507–2520 Varenicline (Chantix) and bupropion (Zyban and others) are effective treatments for tobacco use disorder, but their use (and sales) took a big hit in 2009 when the FDA slapped both with black box warnings linking them to psychiatric complications, including suicidal ideation. Although

Research Update

The COMBINE Study: A Core Paper in the Treatment of AUD

From The Carlat Addiction Treatment Report, Medical Issues in Addiction Practice

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

Research Update

Amphetamines and Topiramate for Cocaine Use Disorder

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Topics: Cocaine | Pharmacology | Research | Research Update

Review of: Levin FR et al, Drug Alcohol Depend 2020;206:107700 In 2017, an estimated 2.2 million Americans used cocaine, with about 966,000 of them meeting criteria for cocaine use disorder (CUD) (SAMHSA, 2018). Unfortunately, there are still no FDA-approved treatments for CUD. Amphetamines increase synaptic dopamine transmission and may therefore re

Research Update

Does Baclofen Titrated to High Doses Reduce Alcohol Use?

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Review of: Rigal L et al, Addiction 2019 Dec 13 [Epub ahead of print] Baclofen is a muscle relaxant and anti-spasmodic that has been used off-label for treating alcohol use disorder for many years. The research base is mixed, with studies showing inconsistent efficacy and tolerability at different doses. In this latest randomized, placebo-controlled

Research Update

Gabapentin for Alcohol Use Disorder, Redux

From The Carlat Addiction Treatment Report, Emerging Risks for Old Medications

Review of: Anton RF et al, JAMA Intern Med 2020;180(5):1–9 Gabapentin has had mixed results in the treatment of alcohol use disorder (AUD), but it is clearly effective in the treatment of alcohol withdrawal syndrome (AWS). In this study, researchers tested whether gabapentin might be effective specifically in treating adults with AUD who also had a

Clinical Update

How to Prescribe Omega-3 Fatty Acids

From The Carlat Psychiatry Report, Living With Mental Illness

Omega-3 fatty acids (“fish oil”) claim broad benefits in physical and mental health and have even made it into a few treatment guidelines in psychiatry. But most products on the shelf do not have the right ingredients for psychiatric use. In this article, I’ll review how and when to use omega-3s. Mechanism Omega-3s are “essential fatty acids

Research Update

Genetic Testing in Depression

From The Carlat Psychiatry Report, Overdiagnosis

REVIEW OF: Perlis RH et al, Depress Anxiety 2020;37(9):834–841 STUDY TYPE: Randomized controlled trial By tailoring medications to a patient’s genetic profile, pharmacogenomics promises less medication trial and error, fewer side effects, and better overall outcomes. But does knowing a patient’s pharmacogenetic profile really improve treatme

Research Update

Two Negative Studies of Mirtazapine and Riluzole for PTSD in Veterans

From The Carlat Psychiatry Report, Depression

Review of: Davis LL et al, J Clin Psychiatry 2020;81(6):20m13267; Spangler PT et al, J Clin Psychiatry 2020;81(6):20m13233 Type of Studies: Randomized, placebo-controlled trial; randomized controlled trial Medications for posttraumatic stress disorder (PTSD) don’t have a great track record, particularly in combat-related trauma. Prazosin, risperid

Research Update

Shining a Light on PTSD

From The Carlat Psychiatry Report, Depression

Review of: Youngstedt SD et al, Mil Med 2021 (Epub ahead of print) Study type: Randomized, sham-controlled trial As stated in the previous brief, PTSD is difficult to treat, and numerous interventions for PTSD have failed with veterans. This study took a different approach; it is the first randomized controlled trial of light therapy for PTSD. Conduc

Research Update

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

From The Carlat Psychiatry Report, Mood and Menopause

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

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

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

Research Update

Pharmacology for GAD: Complex Choices

From The Carlat Psychiatry Report, Adult ADHD

Review of: Slee A et al, Lancet 2019;393(10173):768–777 Study Type: Network meta-analysis With over 2 dozen choices, how do we pick a medication for generalized anxiety disorder (GAD)? The authors of this network meta-analysis sought to answer this question. Network meta-analysis allows researchers to gauge treatments that haven’t been directly c

Research Update

Olanzapine for Anorexia Nervosa

From The Carlat Psychiatry Report, Adult ADHD

Review of: Attia E et al, Am J Psychiatry 2019;176(6):449–456 Type of study: Randomized, double-blind, placebo-controlled trial Antipsychotics have been tried in anorexia since 1960, but their success has been mixed and often outweighed by their risks. Seven controlled trials have tested atypical antipsychotics in anorexia, and although most were p

Research Update

Is There a Case for Cannabis in the Treatment of Pain?

From The Carlat Psychiatry Report, How to Talk about Medication

Review of: Da Vita et al, JAMA Psychiatry 2018;75(11):1118-1127 Study Type: Meta-analysis of placebo-controlled trials In the midst of the opioid epidemic, researchers are looking for new ways to treat chronic pain. Interestingly, states that have legalized medical marijuana have fewer opioid prescriptions but no clear reduction in mortality over

Research Update

Another Black Eye for Prazosin in PTSD?

From The Carlat Psychiatry Report, Side Effects Part II

Review of: McCall W et al, J Clin Psychopharmacol 2018;38(6):618–621 Study Type: Randomized single-blind controlled trial (pilot study) Prazosin has become a mainstay in the pharmacologic treatment of PTSD. A selective antagonist of the noradrenergic alpha-1 receptor, it has modest benefits in sleep and nightmares that are supported by around ha