Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
Do you use any alternative or non-FDA-approved treatments for smoking cessation?
For a non-medication, non-nicotine option, NADA auricular acupuncture has had some evidence-based success in tobacco cessation. It can also be somewhat helpful for anxiety and insomnia. The results are not always mind-blowing, but the risks are also not high so, in general, the outcome tends to be w...
What is your approach to addressing dementia-related agitation for patients living at home with family?
There is absolutely no simple way to answer that question. Even when the family is providing a very calm and nonconfrontational environment, avoiding any possible way of causing the agitation, it is virtually impossible to predict when and why a person with dementia would become agitated, angry, unp...
What is your next step in management for patients who develop sexual side effects on an SSRI (anorgasmia, low libido, etc.) but are responding well to therapy?
Managing side effects from SSRI medications is a key component of treating patients in the outpatient setting who are suffering from depression and/or anxiety. This is doubly true given the fact that primary care is often the most accessible, and often most trusted, source for patients to make their...
Have you found clinical differences between the branded and generic forms of psychiatric medications?
I definitely saw a difference between various forms of bupropion when it became generic. At the time, research suggested that the different delivery systems for bupropion produced very different blood levels and differently timed release. I usually hear about differences between the generics and bra...
How do you counsel patients with depression who ask about the role of the gut–brain axis (e.g., probiotics, diet, or microbiome-targeted interventions) in their symptoms?
I usually explain to patients that the gut-brain connection is real, and one of the most consistent findings is that diet matters. A Mediterranean-style, fiber-rich diet - high in vegetables, fruits, whole grains, legumes, and healthy fats - has good evidence showing meaningful improvement in mild t...
How do you approach requests from attorneys to complete paperwork supporting your patient’s application for long-term disability?
If the diagnosis does not support disability, I will give the attorney a call. This saves time, money, and my effort of writing a report. They may provide more collateral, or they may not use me. Either way, I am not stuck defending an untenable position. In terms of ambiguous questions, I try to be...
How do you determine disposition when a patient presents to an outpatient psychiatry visit with recent self-injury that may require medical attention?
Self-injury can present a complicated and anxiety-provoking clinical situation, yet it is not uncommon in psychiatric practice. Such behavior may reflect a range of psychological processes, including acute distress, personality pathology, or genuine suicidal intent. Because the underlying meaning of...
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...
In your opinion, when does a psychiatric medication regiment become "polypharmacy"?
I feel like that question is likely to start a fight (just kidding). I imagine most psychiatrists have their own strongly held opinion on this matter. When I was a resident, someone told me that once the number of psychiatric medications increases past 3, they become concerned that it is too difficu...
What varying approaches do you take in suicide risk assessments?
I agree with the following from Dr. @Dr. First Last: "Ultimately, no scale or method is going to be perfect. We are unfortunately bad at predicting which individuals with suicidal ideation progress to an attempt. The most we can do is gather as much information as possible about how someone is feeli...