Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you approach diagnosing ADHD in patients with significant trauma histories?
It is critical to differentiate significant post-traumatic stress from ADHD. They both present with similar symptoms including anxiety, mood disturbance, emotional dysregulation, hyperactivity, difficulty concentrating and feeling "scattered", impulsivity, and interpersonal difficulties. As with any...
What adjustments do you make for ADHD medications during puberty?
I do not make anticipatory changes specifically related to puberty, as each individual is unique. Rather, I regularly meet with parents and tweens during medication reviews to discuss what target symptoms we are treating and how the medication is helping. I provide general guidance that as kids grow...
Have you observed adverse mental health side effects in patients who start montelukast?
A female patient with anxiety but no history of depression or suicidal tendencies developed suicidal ideation with intrusive thoughts while taking montelukast. These were resolved within days of stopping the medication. I also treated a child brought in by his parents for extreme and sometimes viole...
Which features help you distinguish prolonged grief disorder from major depressive disorder?
Prolonged grief disorder is in the DSM‑5‑TR, but I do not diagnose it often. I have seen a case where the grief was both excessive and clearly pathological, and the depth of the loss was profound. The person presented more than a year after the death and also met criteria for major depressive disord...
When do you refer a patient with difficult-to-treat depression for esketamine nasal spray versus IV ketamine treatment?
For treatment-resistant depression (TRD), intravenous ketamine is slightly more efficacious than intranasal esketamine (Spravato), probably due to more controlled bioavailability (all the substance administered is absorbed) and better personalization of doses. However, IV ketamine is usually not cov...
How do you manage MAT for opioid use disorder in lung transplant patients during the peri/postoperative period?
There is currently no evidence regarding mOUD in lung transplants. Available research represents generally a weak quality of evidence regarding opioid use for pain control before and after lung transplant. Non-opioid analgesic interventions, including thoracic epidural anesthesia and intercostal ner...
How do you manage lamotrigine or lithium-induced acne?
For Lithium, I have referred patients to dermatology but it seems the interventions suggested such as Doxycycline, Spironolactone, or Bactrim do not fully help. I try to reduce the dose if possible or switch to another mood stabilizer if the acne is severe and bothersome that it is making the patien...
Has the April 2026 Cochrane review on anti-amyloid antibodies changed how you counsel older adults with early Alzheimer's disease about whether to pursue treatment with lecanemab or donanemab?
The April 2026 Cochrane review has not fundamentally changed my counseling, but it has strengthened my caution. It reinforces that lecanemab and donanemab clearly remove amyloid, yet any average clinical benefit appears small and remains difficult to interpret confidently given the numerous threats ...
What non-pharmacologic recommendations do you provide for patients with ADHD?
It might surprise many colleagues, but in my psychiatric practice, the most powerful non-pharmacological intervention for adult ADHD is not an elaborate productivity system. It is simply bearing witness. By the time an adult with ADHD reaches our care, they have usually spent decades interpreting ex...
What pharmacological management do you consider for self-injurious behavior in patients with autism spectrum disorder?
This is a great question but requires a nuanced answer. It all depends. In short, what I think the clinician needs to know is whether the patient with ASD and self-injury has a treatable condition that is driving self-injury. Perhaps the most critical is whether the patient has a medical problem tha...