Psychopharmacology and Psychiatry Updates

Dr. Chris Aiken, a psychiatrist and educator, dives deep into pharmacogenetics-guided dosing. He reveals how understanding whether patients are poor or rapid metabolizers can change treatment outcomes dramatically. Aiken emphasizes tailored dosing strategies: for poor metabolizers, he suggests starting low and going slow, while for rapid metabolizers, targeting higher doses works best. He also discusses the importance of monitoring clinical response and serum levels, highlighting a personalized approach to psychiatric care. A must-listen for mental health professionals!

Dr. Oliver Freudenreich, a leading psychiatrist in psychopharmacology, shares insights from the newly released INTEGRATE guidelines for schizophrenia treatment. He discusses the importance of establishing a universal treatment algorithm to enhance care standards. Key points include the early use of long-acting injectables and clozapine for treatment-resistant patients, as well as recommendations for first-episode antipsychotics. Freudenreich emphasizes shared decision-making and integrating medical management for optimal patient outcomes.

Dr. Chris Aiken, a prominent psychiatrist and editor-in-chief known for his expertise in psychopharmacology, dives into the world of pharmacogenetics. He discusses essential genetic tests that matter in psychiatric practice, cutting through marketing misconceptions. Learn about vital metabolic tests like CYP2D6, CYP3A4, and the implications of HLA-B*1502 for drug safety. He explains how understanding genetic variability can prevent severe side effects and improve patient outcomes, highlighting real-world applications and FDA requirements.

In this discussion, Dr. Paul Zarkowski, a psychiatrist and faculty contributor, dives into his comparative study on lithium versus quetiapine for treatment-resistant depression. He reveals real-world data on efficacy and side effects that spans an entire year. The conversation explores short-term remission rates and how these treatments fare against STAR*D findings. Zarkowski highlights the implications of side effects and the importance of individualized treatment choices, providing valuable insights for clinicians navigating difficult cases.

Psychiatrist Lauren Osborne, an expert in perinatal psychopharmacology, dives into the complex interplay of postpartum psychosis and bipolar disorder. She shares insights on the use of mood stabilizers, particularly lithium, in breastfeeding mothers. Osborne emphasizes that sleep disruption often influences breastfeeding choices more than drug exposure. She also outlines the relative risks of medications like lamotrigine and lithium during lactation, advocating for early lithium treatment while managing risks for both mother and infant.

In this episode, we explore brexanolone and zuranolone—the first FDA-approved medications specifically for postpartum depression. How do these neurosteroid-based treatments work differently than traditional antidepressants, and could they offer relief in just days rather than weeks? Faculty: Lauren Osborne, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Understanding Postpartum Mood Disorders: A Comprehensive Guide The Role of Brexanolone and Zuranolone in Postpartum Depression

In this episode, we explore lumateperone for treating major depressive episodes with mixed features – that challenging presentation where patients experience depression alongside racing thoughts and restlessness. Can we effectively treat both the despair and the activation without triggering mania? Dr. Kristin Raj examines the evidence and clinical implications for this understudied population. Faculty: Kristin Raj, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.75 CME: Quick Take Vol. 76 Lumateperone for Depression with Mixed Features: Is It Effective?

Dr. Lauren Osborne, a perinatal psychiatrist from Weill Cornell Medicine, dives into the intersection of antidepressants and breastfeeding. She reassures listeners that most psychiatric medications are compatible with nursing mothers. They discuss how postpartum women often respond more quickly to treatment and the importance of selecting medications based on prior successes. Dr. Osborne highlights the factors influencing how drugs enter breast milk and stresses that maternal treatment needs should take priority, especially for vulnerable infants.

Scott Beach, a psychiatrist and expert commentator, shares insights from a crucial case-control study on QT prolongation linked to psychiatric medications. He discusses the rarity and unpredictability of torsades de pointes, revealing that single antidepressant or antipsychotic use shows no significant risk, while polypharmacy does. Beach emphasizes the importance of careful monitoring of QTc values and addressing reversible factors, urging clinicians to avoid knee-jerk reactions in medication management for psychiatric patients.

Dr. Lauren Osborne, a perinatal psychiatrist from Weill Cornell Medicine, unpacks the complexities of postpartum OCD versus postpartum psychosis. She reveals that while intrusive thoughts about infant harm are common in OCD, they indicate serious risks in psychosis. The conversation includes effective ways to ask mothers about these thoughts safely and highlights key diagnostic differences. Dr. Osborne emphasizes the importance of accurate diagnosis for proper treatment and safety, providing insights into effective therapies for both disorders.