Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
How do you decide which commercially available pharmacogenetic test to use for your patients?
I try to avoid the use of these types of tests because my experience is that they overpromise what is possible for them to deliver to the patient/consumer. It may be the case that if you have decided an SSRI would be the best treatment, then perhaps these tests can tell you which SSRI might be metab...
How do you monitor and discuss the sexual side effects of SSRIs with adolescents?
Much of this depends on the individual adolescent. During my initial evaluation, I typically obtain a confidential sexual/relationship history with the adolescent. When completing an informed consent with a teen, I will refer back to this history and ask if anything has changed. I'll then frame the ...
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...
What is your approach to treating panic attacks/disorder with psychotic features?
Stelazine has FDA approval for non psychotic anxiety - I've used it to good yet limited success (n=2). 2 mg po bid prn
What are your preferred treatments for disrupted nighttime sleep in elderly patients with narcolepsy already taking sodium oxybate?
The treatment depends on what is causing the disruption. Before I consider any medication, I recommend a thorough investigation of possible causes of the disruption. For example, has sleep apnea been ruled out? Is the patient taking alerting substances close to bedtime? What is the sleep environment...
Have you completed any training to prepare for offering psilocybin treatment in the event that it eventually becomes FDA-approved for difficult-to-treat depression?
It seems that places that offer TMS and ketamine will be the ones to adopt it, as they already have the infrastructure for it. I don't see generalists using it that much.
How do you talk to patients about psychedelic clinical trials for the treatment of major depressive disorder or PTSD?
These discussions usually come up with patients who have not been satisfied with prior pharmacologic treatments for depression or PTSD. I see my role as educating patients so that they can make the choice that is best for them. I will talk to them about the potential risks and benefits of psychedeli...
How have you incorporated Eye Movement Desensitization and Reprocessing (EMDR) into your outpatient psychiatric practice?
Training is formal and takes one week, and the training I had was truly excellent and experiential. The EMDRIA website has a list of trainers and trainings. I have found EMDR to be a powerful modality that rapidly clears the negative emotions related to past traumatic or unpleasant events. I use it ...
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...
When do you refer patients with difficult-to-treat depression for ECT rather than other interventional psychiatric treatments, such as TMS or esketamine?
First, you have to take into account the patient's wants. A decent amount of patients are scared of ECT and want to exhaust all pharmacological options possible. After I deem it necessary that ECT is in the best interest of the patient, I will explore their willingness. Also, access to ECT can be a ...