Controlled substances are medications with a potential for abuse or misuse. They are often, also, medications that have powerful effects on brain function. Common controlled substances that doctors prescribe include: Narcotic pain medications (Demerol, Norco, Tyco, etcetera) Stimulant medications (Adderall, Ritalin, Concerta, etcetera) Benzodiazepines and similar sedating and anti-anxiety medications (Xanax, Valium, Ativan, Ambien, etcetera) Testosterone and some other hormone …
TMS for Depression – Repeat Treatment
TMS is an expensive, time-consuming, but effective treatment for depression, but how should it be used for treating patients with chronic depression? And for those who have an initial positive response when should we consider another course of TMS (known as reintroduction therapy)? These are all questions which have not been adequately addressed in the research literature. A study published in …
Pregnancy and Bipolar
Pregnancy Outcomes in Women with Bipolar Disorder A recent review of the topic of bipolar and pregnancy from the MGH Center For Women’s Mental Health on November 14, 2016 sparked us to write this post. When talking with a bipolar woman contemplating pregnancy there are two considerations: what additional risks to the unborn child are created by taking psychiatric medication and what risks exist …
Insomnia Relief
How to find insomnia relief is a question that many people we work with struggle with. A recent editorial in JAMA Psychiatry and the accompanying research article suggests that the online program that we’ve been recommending to our patients for years (SHUTi) is the treatment of choice for insomnia. We have been extremely pleased with the results from this program which can …
Requesting Out of Network Coverage for Psychiatrist
EXTENDING MEDICAL BENEFITS TO NON-PREFERRED PROVIDER PHYSICIANS Some of the most heartrending calls that we receive from potential patients have to do with people who are unable to find psychiatrists who are covered under their insurance plan. One solution may be to request out of network coverage for a psychiatrist. Background There are several problems that make this a common …
Lithium Thyroid Effects
A young woman who has had a relatively good response to low dose lithium treatment has labs that suggest she may be developing hypothyroidism (low thyroid) and asks what her options are. What can be done to treat the problem? What risks are there for developing it? And what would happen if she decided to taper off the lithium, would …
Lithium Weight Gain
Does lithium cause weight gain? It is remarkable how difficult it can be to find out the answers to relatively simple questions on the internet. One of my patients asked me about the effect of lithium on weight and, while I was explaining my experience with many hundreds of patients treated with lithium (not a significant cause of weight gain …
SSRI Antidepressants and Pregnancy – 2016
Several recent articles provide additional information about the effects on the infant of exposure to SSRI antidepressants during pregnancy. A large study published in Pediatrics adds to information that suggests that exposure to SSRI antidepressants, particularly late in pregnancy, may be associated with birth complications. As with other studies, one major limitation in the design of the study is that it …
Mood Stabilizers
There is nothing like a patient’s request to spur me on to tackle a long delayed project. Noting that a significant percent of the patients I see have bipolar, one of my patients wondered why I did not have any information on this website that addressed, in an organized way, the considerations that go into selecting a mood stabilizer. I …
CBT for Seasonal Affective Disorder
CBT May Be More Durable Treatment for SAD Than Light Therapy Six weeks of cognitive-behavioral therapy sessions tailored for seasonal affective disorder (CBT-SAD) may lead to longer-lasting effects than those seen with light therapy, according to a recent study in AJP in Advance. Light therapy is a proven approach to treat acute SAD, but previous studies show that most patients …