Antidepressants for Suicidal Ideation in Depressed Patients?

Topics: Antidepressant | Cognitive Behavioral Therapy | Depression | Suicidality

REVIEW OF: Dunlop BW et al, Psychol Med 2019;49(11):1869–1878 TYPE OF STUDY: Post-hoc analysis of a randomized controlled trial Antidepressants and cognitive behavior therapy (CBT) appear roughly equivalent for treating depression (Weitz ES et al, JAMA Psychiatry 2015;72(11):1102–1109), but might they differ in their efficacy for individual sy

Electroconvulsive Therapy: A Primer

Topics: brief pulse | Depression | ECT | Innovations | Ketamine | maintenance ECT | memory loss | retrograde amnesia | Stigma | Suicidality | TMS | unilateral vs bilateral

CHPR: Welcome, Dr. Seiner. Can you tell us what led to your interest in electroconvulsive therapy (ECT) and neurotherapeutics? Dr. Seiner: I went to the University of Michigan and got a degree in chemical engineering, but I decided I didn’t want to fractionate oil for a living, so I went to medical school thinking I would be an internist. While in me

Intravenous Ketamine for Teen Depression

Topics: adolescents | Depression | Free Articles | Ketamine | Suicidality

REVIEW OF: Dwyer JB et al, Am J Psychiatry 2021;178(4):352–362 TYPE OF STUDY: Randomized midazolam-controlled trial Treatment-resistant depression (TRD) is a growing concern in teenagers. Although intravenous ketamine has shown clear and immediate improvement of TRD in adults, there is little research to show its effectiveness in teens, and each

Borderline Personality Disorder in the ED

Topics: Borderline Personality Disorder | Countertransference | Emergency Department | emotion dysregulation | Good Psychiatric Management | interpersonal stressors | Personality Disorders | Suicidality | Working With Families

CHPR: What are some common issues that you encounter with patients with borderline personality disorder (BPD) in the psychiatric emergency department (ED)? Dr. Hong: First, we should remember that individuals with BPD are prevalent in every psychiatric setting, but especially the ED. About 10%–15% of all psychiatric ED patients have BPD, and these pa

Self-Harm in Adolescents With ADHD

Topics: ADHD | affective disorders | alcohol abuse | alcohol dependence | co-morbidities | Non-suicidal self-injury | psychotic disorders | Suicidality

REVIEW OF: Balázs J et al, BMC Psychiatry 2018;18(1):34 What is the relationship between ADHD and self-harm and what can we do about it? ADHD is quite common, affecting 4%–6% of children and adolescents, and non-suicidal self-injury (NSSI) is also common, affecting about 5% of all people in the community and up to 80% of people with psychiatric di

The Effect of Age and Pubertal Stage on Mental Health in Gender-Incongruent Youths

Topics: adolescents | children | GAMC | GDD | Gender Affirming Medical Care | Gender Dysphoric Disorder | Hormone Replacement Therapy | HRT | Mental Health | Suicidality

Review of: Sorbara JC et al, Pediatrics 2020;146(4):e20193600 Gender incongruence means that a young person identifies with a gender that’s different from the one they were born with. These youths have an elevated risk of suicide and other psychiatric problems. Gender-affirming medical care (GAMC), such as hormonal therapies, can reduce those risks

Intranasal Esketamine: New Hope for Suicidal Patients?

Topics: Depression | Esketamine | Fast-acting | Free Articles | Intra-nasal | Ketamine | Management | Psychopharmacology | Suicidality

It’s likely your patients have asked you about esketamine. The buzz is that it’s a rapid-acting miracle cure for suicidal depression. Dr. Thomas Insel, former director of NIMH, declared that ketamine “might be the most important breakthrough in antidepressant treatment in decades” (www.nimh.nih.gov/about/directors/thomas-insel/blog/2014/ketamine

Treating Pandemic-Associated Trauma in Children and Adolescents

Topics: COVID-19 | PTSD | ScreeninGeg | Suicidality | TFCBT | Trauma

CCPR: Tell us about your backgrounds. Dr. Steinberg: I’m the Associate Director of the National Center for Child Traumatic Stress at UCLA. Dr. Ahmadi: I’m Assistant Professor of Psychiatry at UCLA and Director of Family Trauma Distress at Olive View, and Dr. Steinberg and I worked together with colleagues to develop our UCLA Brief COVID-19 Screen

Suicidality and SSRI’s: An Update

Topics: SSRIs | Suicidality

Just when we thought we could finally dismiss the notion that SSRIs cause suicidal ideation, along came the Brits! On June 10, 2003, the British counterpart of our FDA (in Britain, this is the MHRA--Medicines and Healthcare Products Regulatory Agency) issued a "Dear Colleague" letter announcing that Seroxat (the British version of Paxil) should not be u

Update: Is Watching 13 Reasons Why Bad for Teens?

Topics: Bullying | Contagion | Media | Prevention | Research Update | Risk | Suicidality | Suicide | teens

Review of: Niederkrotenthaler T et al, JAMA Psychiatry 2019. doi: 10.1001/jamapsychiatry.2019.0922 Several studies have examined whether Netflix’s 13 Reasons Why is good or bad for teens. Results have been mixed. In the CCPR March/April 2019 issue, we reported a study finding that most suicidal ideation decreased after watching the first season of

Varenicline and Bupropion: Soaring Again With EAGLES?

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

Getting Uncomfortable with Esketamine

Topics: Antidepressant Augmentation | Antidepressants | Brain Devices | Depression | Depressive Disorder | ECT | Esketamine | Free Articles | Ketamine | Neurotoxicity | Novel Medications | rTMS | Suicidality | TMS | Transcranial Magnetic Stimulation | Treatment-Resistant Depression

Esketamine (Spravato) was approved for treatment-resistant depression in 2019. In this interview, Dr. Williams (who has no relationship with Janssen Pharmaceuticals, Inc) addresses some lingering doubts that have been raised about the medicine. TCPR: Where does esketamine fit in the list of interventional therapies for depression, like repetitive tra

Study Ignites Controversy Over Trazodone and Suicide

Topics: Hypnotics | Research Update | Suicidality | Trazodone

Review of: Lavigne JE et al, J Gen Intern Med 2019;34(8):1554–1563 Study Type: Observational comparative safety study Trazodone is one of the most widely prescribed sleep aids in the US despite lacking FDA approval for insomnia. But what if patients taking trazodone attempted suicide at a rate over 1.5 times that of those taking zolpidem (Ambien)? L

Another Black Eye for Prazosin in PTSD?

Topics: Hypnotics | Insomnia | Nightmares | Prazosin | PTSD | Research | Research Update | Sleep | Suicidality

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

Ask the Editor: Should You Prescribe Lithium to Suicidal Patients?

Topics: Lithium | Pharmacology | Suicidality

Dear Dr. Aiken: You recommended lithium for suicidal patients in the TCPR 2018 summer issue, but isn’t there a risk of overdose with this strategy? Dr. Aiken: From firearms to bridges, the suicide rate goes down when we erect barriers to the means. Barriers work because suicidal impulses are brief, lasting only 1–2 hours on average. It

Bullying and Suicidality: Some Practical Tips

Topics: Bullying | Depression | Free Articles | Suicidality

What can you do when one of your patients reports being bullied? Research has shown that being bullied increases the risk of depression, anxiety, and suicidality in children. In this article, we’ll give you some tips for how to ask about bullying, how to assess its impact, and how to help your patients and their families deal with the problem. How