Naltrexone is one of several new medications (the others are topirimate and acamprosate) that has been shown to reduce the risk of relapse in people with alcohol use disorders. But naltrexone is used relatively rarely for this purpose. A new study suggests that it may be possible to predict which patients are especially likely to respond to naltrexone treatment. The …
B Vitamins and Depression and Cognition
We ran across a Q&A from Consumer Lab on the role of B vitamins in depression which sparked us to update and expand this section of our page on nutritional supplements. ConsumerLab.com Answers Question: I’ve heard that having low B-12 or B-6 can cause depression. Is that true? Answer: Yes, being deficient in vitamin B-12 or B-6 can cause …
Depression Therapeutics and Mechanisms
The September 15, 2016 edition of Biological Psychiatry is devoted to updates in the area of psychobiology that relate to depression and its treatment. In this blog post I will summarize some of those studies to give you a sense of what is going on in the field. Some of these studies may not be replicated in follow-up research, but some …
A New Model of Anxiety and Fear
We often tell our patients that the treatment of anxiety is primarily through psychotherapy, in contrast to the treatment of mood disorders which is often based on medications or brain stimulation. In fact, it is one of the more frustrating aspects of psychiatry that there has been so little progress in terms of the biological treatments of anxiety and fear …
Why SSRIs May Increase Anxiety Short Term
SSRIs are among the most commonly prescribed medications for chronic anxiety, but not infrequently these medications may be associated with a short term increase in symptoms that precedes the long term benefit. In an elegant series of studies published online in late August 2016 in the premier scientific journal, Nature, researchers from the NIH and the University of North Carolina at …
Measurement Based Care Improves Outcomes
Patients at Gateway Psychiatric are sometimes perplexed by the amount of time and energy we devote to tracking how they are doing. It can seem annoying to answer questions repeatedly or to fill out forms. An article in the journal Psychiatric Services summarizes the data that shows that this process (known as “measurement based care” or MBC) is associated with significantly …
Prescription Savings
We have just updated the “links” page on this site with information about prescription medication savings and costs based on online research and an online discussion on the Psychopharmacology listserve. Pharmacist Stephen Saklad summarized information about local pharmacies – “Many of the Pharmacy Benefits Managers that are used by the insurers forbid the pharmacy to charge the lowest price, but …
Genesight – Genetic Testing to Predict Medication Response
We have been using the Genecept Assay from Genomind for several years to help guide treatment selection in patients with either unusually high rates of side effects from medications or those who have failed multiple trials of medications. Although the test can be expensive, costing anywhere from a couple of hundred dollars to five hundred dollars or more, it is our experience …
Antipsychotic Medications in Pregnancy
After decades during which the accepted medical dogma was that pregnant women should avoid all medications, the last 10 years have shown a significant increase in the quality of information available to help guide pregnant women in making decisions about which medications to continue taking during pregnancy. A recent editorial in the JAMA Psychiatry gives a sense of the context and …
Antidepressants Alter Gene Expression
An interesting study looked at similarities and differences in the effects of two medications that have anti-depressant effects and yet are extremely different in terms of how they work: ketamine and imipramine (a tricyclic antidepressant). This industry supported study looked at the effects of these two agents on a reward circuit (involving the prefrontal cortex (PFC), nucleus accumbens, hippocampus, and amygdala – …