Research Update Carlat Reports

Research Update

From The Carlat Psychiatry Report, Bipolar Disorder

Review of: Nasser A et al, Int J Clin Pract 2021;75(8):e14330 Study type: Meta-analysis of randomized controlled trials Viloxazine (Qelbree) just got FDA approval in 2021 for the treatment of ADHD in children and adolescents, and the FDA is reviewing data in adult ADHD. Viloxazine has a long history of use as an antidepressant in Europe. Like atomoxet

Research Update

Listening to Depression: The Importance of Addressing Hearing Loss

From The Carlat Psychiatry Report, Bipolar Disorder

Topics: Geriatric Psychiatry | Hearing loss | Research Update

REVIEW OF: Marques T et al, Eur Arch Otorhinolaryngol 2021; Epub ahead of print STUDY TYPE: Randomized open-label controlled trial Age-related hearing loss is associated with depression, poorer physical and social functioning, and decreased quality of life, but can hearing aids reverse those trends? This study examined the effects of “aural rehabili

Research Update

Brexpiprazole Ineffective in Mania

From The Carlat Psychiatry Report, Mood Disorders

REVIEW OF: Vieta E et al, J Psychopharmacol 2021;35(8):971–982 TYPE OF STUDY: Phase III randomized controlled trials Brexpiprazole is FDA approved in schizophrenia and as an adjunct for major depression and is one of the better-tolerated antipsychotics. Like aripiprazole, it is a partial D2 and 5-HT1A agonist. Unlike most antipsychotics, brexpiprazo

Research Update

Omega-3s and Metabolic Risks in Schizophrenia

From The Carlat Psychiatry Report, Mood Disorders

REVIEW OF: Pawełczyk T et al, Schizophr Res 2021;230:61–68 TYPE OF STUDY: Randomized, double-blind, placebo-controlled trial Patients with schizophrenia are at greater risk for metabolic syndrome, whether from lifestyle, antipsychotic side effects, or the illness itself. Omega-3 fatty acids have metabolic benefits in the general population, and lev

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

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

Research Update

Beta Blockers and Depression: The Controversy Revisited

From The Carlat Psychiatry Report, Mind-Gut Connection

Topics: Alpha Agonists | Beta-blockers | Guanfacine | Medical Comorbidities | Research Update

Review of: Agustini B et al, J Hum Hypertens 2020;34(11):787–794 Study Type: Cross-sectional Antihypertensives are among the world’s most widely prescribed drugs, but many of them impact pathways associated with depression. Beta blockers have long been believed to cause depression, but most of the studies suggesting this were carried out decades a

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

Research Update

Guanfacine ER for Adults With ADHD?

From The Carlat Psychiatry Report, Mood and Menopause

Review of: Iwanami A et al, J Clin Psychiatry 2020;81(3):19m12979 Study type: Randomized, double-blind, placebo-controlled trial Stimulants are rapid, safe, and effective first-line treatments for many adults with ADHD. However, there are inevitably patients for whom stimulants are not indicated or tolerated—those with arrhythmias or stimulant use d

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

Insight in Therapy: Still Relevant After All These Years

From The Carlat Psychiatry Report, Traumatic Brain Injury

Topics: Psychotherapy | Research Update

Review of: Jennissen S et al, Am J Psychiatry 2018;175(10):961–969 STUDY TYPE: Systematic review and meta-analysis What makes psychotherapy work? Contenders abound, including the therapeutic alliance, behavior change, and cognitive restructuring. This meta-analysis looked at the role that insight plays in psychotherapy outcomes. The authors defined

Research Update

A New Antipsychotic for Bipolar Depression

From The Carlat Psychiatry Report, Traumatic Brain Injury

Lumateperone (Caplyta) just hit the pharmacy shelves with FDA approval in schizophrenia (see TCPR March 2020), and its manufacturer is pursuing further approval for bipolar depression. So far they’ve completed two phase III trials—one negative and one positive—and the positive one was presented in poster form by Suresh Durgam and colleagues at the

Research Update

Autism: The Goal Posts Have Moved

From The Carlat Psychiatry Report, Borderline Personality Disorder

Topics: Autism | Autism Spectrum Disorder autism spectrum disorder | Diagnosis | Research Update

Review of: Rødgaard EM et al, JAMA Psychiatry 2019;76(11):1124–1132 Study Type: Meta-analysis of meta-analyses We’ve heard a lot about the increasing prevalence of autism, up from 1 in 2,000 in 1965 to 1 in 45 in 2015. What we have not heard are definitive answers as to why. This study used a novel design to explore whether the research has i

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