Psychiatry
Expert discussions on psychopharmacology, behavioral health interventions, and psychiatric care approaches.
Recent Discussions
Have you seen a rise in postpartum psychosis presentations in your own practice this year?
No.
What considerations do you take in starting stimulant medications for the management of adult ADHD?
Adult stimulant prescriptions for ADHD and The Journal of the American College of Cardiology in particular have published several articles in the last few years investigating the cardiovascular risk of long-term use of these medications. There have been three already in 2024 and data remains mixed.I...
What is your preferred antipsychotic for augmenting treatment of major depressive disorder?
Over the years, the overpromotion of antipsychotics as augmenting agents was largely initiated by experts with industry ties, often underemphasizing their significant neurological and metabolic side-effect burden. Today, the trend I see is that their primary use has shifted toward primary care physi...
Do you type or take notes during psychiatry appointments while you talk with patients?
Taking handwritten notes during an interview, therapy session, or assessment creates a fundamentally visceral connection. Phenomenologically, putting pen to paper accentuates the gravity of examining another human mind. A screen creates a third entity in the room; a notebook remains quiet, unobtrusi...
Are you prescribing lithium more or less often than you did five years ago for bipolar disorder?
I am prescribing lithium more often now than 5 years ago. Unfortunately, more psychiatrists are opting to provide bipolar patients with other mood stabilizers. There are excellent reasons to consider lithium for every bipolar patient who has not had an adequate trial (at least 6 months at confirmed ...
How do you work with patients to establish reasonable treatment goals for the management of fibromyalgia-related pain?
Great question. I explicitly tell my patients that I have no magic-bullet– no penicillin or prednisone-adjacent pill – that will swiftly and reliably alleviate their pain. This expectation, that a pill will eradicate disease, makes sense in the wake of the infectious disease revolution, where target...
What treatment and management recommendations do you have for amphetamine-induced skin picking disorder without insight?
Assuming the stimulant is prescribed for ADHD, I recommend dose reduction or switching to a different medication, or, rarely, I recommend the patient consider a "stimulant holiday" for at least 1-2 months. I explain that most of my patients notice improvement with adjustments or breaks from their st...
How do you address parental concern about children becoming addicted to stimulants for ADHD treatment?
In the current environment with an epidemic of fatalities from opiates, the question about addiction to stimulants is timely. I present the parents with the data, which shows that controlled dosing leads to a steady level of dopamine and does not produce a high. Further, studies find that treated ki...
Do you ever give stimulant medication to cover a longer continuous period when treating first responders or healthcare workers who work long shifts?
I think this has to be taken on a case-by-case basis. Some patients with ADHD are genuinely so impaired without their medication that I don't know if they'd be safe acting in emergency situations without something to help them focus on priorities. The other side of that coin is that first responders...
What do you recommend to patients when they are having an acute flare of fibromyalgia symptoms?
Great, this is a really important area and unmet need in the field of fibromyalgia management. Unlike other nociplastic disease states (e.g., migraine), there are no rigorously studied abortive therapies to rapidly treat a flare of centralized pain. Indeed, all the therapies we use for FM are intend...