Psychopharmacology and Psychiatry Updates

Dr. Paul Zarkowski, a psychiatrist and researcher known for his analysis of the STAR*D trial data, dives into the controversial belief surrounding SSRI side effects. He discusses whether these effects truly diminish over time, revealing that some patients may actually face worsening symptoms. Zarkowski explains concepts like survivor bias and presents data showing distinct side-effect trajectories. He also highlights persistent problems such as sexual and sleep-related side effects and stresses the importance of early assessments for effective patient counseling.

David Osser, an associate professor of psychiatry at Harvard Medical School and psychopharmacology expert, shares his insights on treating acute mania. He discusses effective strategies for augmenting lithium, highlighting quetiapine as the preferred add-on due to its mood-stabilizing effects. Osser critiques the overuse of valproate and explains the minimal benefits from combining it with lithium based on the BALANCE study. He also warns of metabolic risks associated with drug combinations, providing vital considerations for patient care.

Join psychiatrist Oliver Freudenreich from Harvard Medical School as he dives into an innovative Mayo Clinic algorithm for selecting antipsychotics for first-episode psychosis. He discusses how the presence of violence influences the choice of medication, recommending options like aripiprazole and olanzapine. He emphasizes the effectiveness and adherence benefits of long-acting injectables and defends olanzapine’s use despite its metabolic risks. The conversation culminates in a practical application of these insights to real cases.

Dr. David Osser, an Associate Professor of Psychiatry at Harvard Medical School and expert in bipolar treatment, argues for lithium as the first-line therapy for classic mania. He presents compelling evidence of lithium's neuroprotective benefits and long-term efficacy, emphasizing its role in reducing suicide risk and preventing episodes. Comparisons of second-generation antipsychotics reveal their limited advantages over lithium. Osser’s insights challenge the reliance on antipsychotics, advocating for lithium's unique advantages in managing bipolar disorder.

In this episode, we explore a head-to-head comparison of trazodone, doxepin, and melatonin for treating insomnia when benzodiazepines are off the table. Which non-benzodiazepine sleep aid offers the best balance of effectiveness and tolerability in real-world psychiatric patients? Faculty: Paul Zarkowski, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.75 CMEs: Quick Take Vol. 74 Melatonin, Trazodone, or Doxepin for Sleep Disorders

Dr. David Osser, Associate Professor of Psychiatry at Harvard Medical School, shares his expertise on managing mixed manic episodes. He discusses the critical timing for adding lithium or valproate to antipsychotics, emphasizing patience and evidence-based strategies. Osser cautions against rushing into combination therapies due to managed care pressures and advocates for temporary use of benzodiazepines to stabilize patients. He weighs the pros and cons of lithium versus valproate and considers carbamazepine as a viable third-line option.

In this episode, we explore a provocative argument for reconsidering disulfiram as a first-line treatment for alcohol use disorder. Could this decades-old medication, often dismissed as outdated and dangerous, actually be more effective than newer alternatives when used in appropriately selected patients? Faculty: David Gorelick, M.D. Host: Richard Seeber, M.D. Learn more about our membership here Earn 0.75 CMEs: Quick Take Vol. 74 Alcohol Use Disorder: Should Disulfiram Be First-Line?

In this episode, we explore the complex pharmacological management of mixed mania, a challenging bipolar presentation affecting up to 40% of manic episodes. Why do traditional mood stabilizers like lithium fall short, and which second-generation antipsychotics emerge as first-line treatments for this dual-symptom condition? Faculty: David Osser, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.5 CME: Lithium: How to Manage Dosage and Side Effects Managing Renal Side Effects of Lithium Therapy

In this episode, we explore psychedelic-assisted therapy in clinical practice, examining how these treatments differ fundamentally from traditional pharmacotherapy. Can psychiatrists reconcile mystical experiences with evidence-based medicine while navigating the complex therapeutic paradigm of preparation, 8-hour sessions, and integration work? Faculty: Franklin King, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CMEs: Use of Psychedelic Drugs in Psychiatry Psychedelic-Assisted Therapy in Clinical Practice

Join Kristin Raj, a psychiatrist and faculty contributor to the Psychopharmacology Institute, as she delves into the intriguing findings of a recent meta-analysis on lurasidone for bipolar depression. Discover why lower doses (40-60mg) may actually be more effective and safer than higher doses, potentially changing prescribing practices. Kristin discusses the risks associated with over-medication and highlights the importance of individualizing treatment. Plus, hear tips on adherence and monitoring for optimal outcomes!