We have been eagerly awaiting the results of controlled studies of psilocybin treatment of depression (used along with psychotherapy). A large multi-center study is still recruiting participants. Meanwhile a great deal of interest in this topic has been stirred up by Michael Pollan and his book How to Change Your Mind. But clinicians have had very little solid science upon …
Cost of Sending Medical Records from Gateway Psychiatric
It is our policy to provide you and other health care providers ready access to necessary medical information. Fortunately, it is easy for us to create a summary of your care that includes our initial assessment, your diagnoses, and a complete record of any medication we may have prescribed. Unfortunately, if you want a complete copy of your record, due …
Life Insurance or Disability Insurance and Confidentiality – the MIB and Limits of HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) has a few limitations that should be considered when you are applying for life insurance or disability insurance. Life insurance and disability or long term care insurance companies ask you for the names of all the doctors who have treated you and your consent to get records from the doctors. The consent …
Walgreens Doesn’t Care – Why I Don’t Approve Refills Automatically
Today one of my patients had a simple request – “Doc, I don’t know if you need to write new prescriptions, but my pharmacy will ask for a refill if I do.” I said that I it is my policy to always write refills in session so that I can make sure that I and my patients understand what medications …
Telepsychiatry Presentation by Dr. Peter Forster
Dr. Forster will be presenting an update on “Telehealth and Psychiatry in an Era of COVID-19,” as part of the Seventh Annual Mood Disorders Summit webcast. Those interested in signing up for this free Continuing Medical Education event visit the Global Medical Education site. The program will include many presentations including… Program Agenda *All times listed are ET Day 1 …
Psychotherapy for Bipolar
People with bipolar disorder are much less likely to receive psychotherapy (26-50% of patients in one study got therapy) as opposed to psychiatric medications (46-90% were treated with medications) according to a study sponsored by the Depressive and Bipolar Support Association. This is not surprising since many mental health professionals were taught when we were in training that bipolar depression …
Limbic and Prefrontal Connectivity and Treatment Selection for Depression
Boadie Dunlop, M.D., M.S., and Helen Mayberg, M.D., both of Emory University School of Medicine, and colleagues assessed resting-state functional connectivity between the subcallosal cingulate cortex (SCC) and three other brain regions—the dorsal midbrain, the ventrolateral prefrontal cortex and anterior insula, and the ventromedial prefrontal cortex—in 122 patients with depression. The patients were then randomized to 12 weeks of cognitive-behavioral …
Impaired Decision Making in Depression – Treatment Implications
Why do depressed people make choices that are unlikely to be rewarded. And why aren’t they willing to make choices that are likely to be rewarded. In fact, why are depressed people less likely than people who are not depressed to choose to take an antidepressant, or begin psychotherapy, or follow the advice of a therapist? A meta-analysis of many …
Try Cognitive Behavioral Therapy for Insomnia First
Although there is reason for optimism about some of the newer medications for insomnia (orexin antagonists) that are coming to market, it remains true that sleeping medications are not the right answer for many people with insomnia. Cognitive behavioral therapy for insomnia (CBTi) has several advantages as an initial treatment. Cognitive Behavioral Therapy for Insomnia First We have been writing …
Functional Connectivity Predicts Response to CBT or Antidepressant
In this study of previously untreated adults with major depression, outcomes after 12 weeks of treatment with randomly assigned medication or CBT were associated with the degree of resting-state functional connectivity between brain regions involved in mood regulation—specifically, the SCC and 1) the left frontal operculum (incorporating the BA47 in the ventrolateral prefrontal cortex [VLPFC] and anterior insula); 2) the …